Provider Demographics
NPI:1003999202
Name:HASSAN, HASHIM J (BDS,DMD,MSD)
Entity Type:Individual
Prefix:DR
First Name:HASHIM
Middle Name:J
Last Name:HASSAN
Suffix:
Gender:M
Credentials:BDS,DMD,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1361
Mailing Address - Country:US
Mailing Address - Phone:334-793-9885
Mailing Address - Fax:334-678-7715
Practice Address - Street 1:1801 W MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1361
Practice Address - Country:US
Practice Address - Phone:334-793-9885
Practice Address - Fax:334-678-7715
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL49741223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL98508OtherBLUE CROSS BLUE SHIELD