Provider Demographics
NPI:1124810221
Name:KAZBOUR, MOHAMED (DDS)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:KAZBOUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 GOLFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1439
Mailing Address - Country:US
Mailing Address - Phone:313-610-5066
Mailing Address - Fax:
Practice Address - Street 1:875 WESTMORELAND AVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1260
Practice Address - Country:US
Practice Address - Phone:877-478-0988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.028024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist