Provider Demographics
NPI:1417127614
Name:HASSAN, RAWA SAADOON (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAWA
Middle Name:SAADOON
Last Name:HASSAN
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 1:1874 EAGLE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3302
Mailing Address - Country:US
Mailing Address - Phone:703-862-8836
Mailing Address - Fax:
Practice Address - Street 1:1874 EAGLE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3302
Practice Address - Country:US
Practice Address - Phone:703-862-8836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151711223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice