Provider Demographics
NPI:1902353113
Name:AOUN, MADONA
Entity Type:Individual
Prefix:
First Name:MADONA
Middle Name:
Last Name:AOUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 YINGER AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2028
Mailing Address - Country:US
Mailing Address - Phone:313-701-4723
Mailing Address - Fax:734-667-1655
Practice Address - Street 1:20491 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2680
Practice Address - Country:US
Practice Address - Phone:313-701-4723
Practice Address - Fax:734-667-1655
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902017084124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist