Dema Mahjoub, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40239 Issued in TX

Practice address

8185 Holly Rd
Grand Blanc, MI 48439-2444

Phone

(810) 695-0842

NPI assigned

Aug 1, 2019

Last updated

Jan 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1564617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1336793835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3496 HERON RIDGE DR",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483094520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8185 HOLLY RD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484392444",
            "telephone_number": "810-695-0842"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4164 S Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757018719",
            "country_code": "US",
            "telephone_number": "903-996-3897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAHJOUB",
        "first_name": "DEMA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-01",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901600309",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "40239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Mackay
• John Macksood, D.O.
• Daniel Thomas Madar, D.C.
• Jill Madore-Olson, SLP, VITAL STIM CERF
• Divya Mahesh, MD
• Benjamin Mairs, MD
• Dominic Edward Maiuro
• Joshua Majkowski
• Amy Leeann Majorana, DO
• Ramotsumi M Makhene, MD

• General Practice Dentistry in Grand Blanc, MI
• Providers in Grand Blanc, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.