Provider Demographics
NPI:1114493343
Name:AL DAHAN, MAIS ABDULMAJEED HASSAN (DDS)
Entity Type:Individual
Prefix:
First Name:MAIS
Middle Name:ABDULMAJEED HASSAN
Last Name:AL DAHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8711
Mailing Address - Country:US
Mailing Address - Phone:213-292-2191
Mailing Address - Fax:
Practice Address - Street 1:3190 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-8711
Practice Address - Country:US
Practice Address - Phone:213-292-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS102896122300000X
TN12247122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist