Provider Demographics
NPI:1558920736
Name:HINNAWI, BASHAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:
Last Name:HINNAWI
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 1:480 WARREN DR APT 204
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-1006
Mailing Address - Country:US
Mailing Address - Phone:862-684-1109
Mailing Address - Fax:
Practice Address - Street 1:5404 NAVE DR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6404
Practice Address - Country:US
Practice Address - Phone:862-684-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS106082122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty