Nizar Naum Mansour, DDS MS

Primary specialty

DentistTaxonomy code 122300000X

License

2901012608 Issued in MI

Practice address

28437 Greenfield Rd
Suite 101
Southfield, MI 48076

Phone

(248) 557-5461

Fax

(248) 559-3163

NPI assigned

Dec 1, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Associated Dentists PC

  • Dentist
  • Oxford, MI
  • NPI 1366518185
  NPD (past) Authorized official
• Associated Dentists PC

  • General Practice Dentistry
  • Southfield, MI
  • NPI 1508934340
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053489807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28437 GREENFIELD RD",
            "address_2": "SUITE 101",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48076",
            "telephone_number": "248-557-5461",
            "fax_number": "248-559-3163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28437 GREENFIELD RD",
            "address_2": "SUITE 101",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48076",
            "telephone_number": "248-557-5461",
            "fax_number": "248-559-3163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSOUR",
        "first_name": "NIZAR",
        "middle_name": "NAUM",
        "name_prefix": "Mr.",
        "credential": "DDS MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901012608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4074460",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "12608",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4065433",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Larissa Manor, LLPC
• Austin Mansaray
• Lisa Mansberry
• Hampton Joseph Mansion, D.O.
• Ceyonce Manson
• Rafid Y Mansour, M.D.
• Rafik E Mansour, PA
• Wafaa Mansour, MD
• Yousif S. Mansour, M.D.
• Map Dental PLLC

• Dentist in Southfield, MI
• Providers in Southfield, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.