Provider Demographics
NPI:1477008951
Name:BARRA, MOHAMMAD HASSAN (DMD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:HASSAN
Last Name:BARRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHARLES ST S UNIT 802
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5454
Mailing Address - Country:US
Mailing Address - Phone:571-449-7198
Mailing Address - Fax:
Practice Address - Street 1:698 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3360
Practice Address - Country:US
Practice Address - Phone:508-583-2256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist