Provider Demographics
NPI:1114199973
Name:HASHIM J. HASSAN,D.M.D.,P.C.
Entity Type:Organization
Organization Name:HASHIM J. HASSAN,D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-793-9885
Mailing Address - Street 1:1801 W MAIN ST
Mailing Address - Street 2:STE.#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:STE.#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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL49741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty