Provider Demographics
NPI:1346785672
Name:AUBURN DENTAL CARE
Entity Type:Organization
Organization Name:AUBURN DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:REFAAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-416-6022
Mailing Address - Street 1:500 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IL
Mailing Address - Zip Code:62615
Mailing Address - Country:US
Mailing Address - Phone:217-434-3721
Mailing Address - Fax:
Practice Address - Street 1:500 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IL
Practice Address - Zip Code:62615
Practice Address - Country:US
Practice Address - Phone:217-434-3721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN VIEW DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-025844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty