Provider Demographics
NPI:1619709698
Name:HAMMOUD, MALACK
Entity type:Individual
Prefix:
First Name:MALACK
Middle Name:
Last Name:HAMMOUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MALAK
Other - Middle Name:
Other - Last Name:HAMMOUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4646 WOODWORTH ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3061
Mailing Address - Country:US
Mailing Address - Phone:313-522-0207
Mailing Address - Fax:
Practice Address - Street 1:4646 WOODWORTH ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3061
Practice Address - Country:US
Practice Address - Phone:313-522-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist