Provider Demographics
NPI:1518155191
Name:TAWOOSI, ABDULHASSAN ALIAKBAR (DDS)
Entity Type:Individual
Prefix:
First Name:ABDULHASSAN
Middle Name:ALIAKBAR
Last Name:TAWOOSI
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 1:650 S LINCOLN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3540
Mailing Address - Country:US
Mailing Address - Phone:951-372-0440
Mailing Address - Fax:951-372-0660
Practice Address - Street 1:650 S LINCOLN AVE STE 102
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3540
Practice Address - Country:US
Practice Address - Phone:951-372-0440
Practice Address - Fax:951-372-0660
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027328122300000X
CA1025691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA102569OtherSTATE ISSUED