Provider Demographics
NPI:1467946541
Name:HASSAN, WAEL AMGAD REFAAT AHMED (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAEL
Middle Name:AMGAD REFAAT AHMED
Last Name:HASSAN
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 1:791 TURNER STREET
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210
Mailing Address - Country:US
Mailing Address - Phone:207-558-0085
Mailing Address - Fax:207-753-0594
Practice Address - Street 1:ASPEN DENTAL
Practice Address - Street 2:791 TURNER STREET
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210
Practice Address - Country:US
Practice Address - Phone:207-558-0085
Practice Address - Fax:207-753-0594
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEDEN46241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program