Provider Demographics
NPI:1467612366
Name:DAWLAT G. HASSO, DDS, PC
Entity Type:Organization
Organization Name:DAWLAT G. HASSO, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWLAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-379-3093
Mailing Address - Street 1:6323 GLYNDEBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2212
Mailing Address - Country:US
Mailing Address - Phone:248-379-3093
Mailing Address - Fax:
Practice Address - Street 1:4139 BALDWIN RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-1225
Practice Address - Country:US
Practice Address - Phone:248-379-3093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010177111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4485840Medicaid