Provider Demographics
NPI:1366649188
Name:BROOKFIELDFAMILYDENTALART
Entity Type:Organization
Organization Name:BROOKFIELDFAMILYDENTALART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAWA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-740-1014
Mailing Address - Street 1:2 OLD NEW MILFORD ROAD
Mailing Address - Street 2:SUITE 3 A
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804
Mailing Address - Country:US
Mailing Address - Phone:203-740-1014
Mailing Address - Fax:203-740-1016
Practice Address - Street 1:2 OLD NEW MILFORD ROAD
Practice Address - Street 2:SUITE 3 A
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804
Practice Address - Country:US
Practice Address - Phone:203-740-1014
Practice Address - Fax:203-740-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty