Provider Demographics
NPI:1043437825
Name:HASSON, MICHAEL LEE (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:HASSON
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 1:1221 FLORAL PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6235
Mailing Address - Country:US
Mailing Address - Phone:910-793-0440
Mailing Address - Fax:910-793-0441
Practice Address - Street 1:1221 FLORAL PKWY STE 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6235
Practice Address - Country:US
Practice Address - Phone:910-793-0440
Practice Address - Fax:910-793-0441
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU65424Medicare UPIN