Provider Demographics
NPI:1164916110
Name:HABASHI, MINA IHAB (DDS)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:IHAB
Last Name:HABASHI
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 1:1491 CHENIN RUN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1247
Mailing Address - Country:US
Mailing Address - Phone:626-253-3971
Mailing Address - Fax:
Practice Address - Street 1:36173 EUCLID AVE STE B
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4410
Practice Address - Country:US
Practice Address - Phone:440-290-4256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0254971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice