Provider Demographics
NPI:1578595666
Name:HASSAN, MOHAMMED HASHIM (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:HASHIM
Last Name:HASSAN
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 1:200 GROVE PARK LN
Mailing Address - Street 2:SUITE 610
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-5911
Mailing Address - Country:US
Mailing Address - Phone:334-699-7777
Mailing Address - Fax:334-699-7778
Practice Address - Street 1:200 GROVE PARK LN
Practice Address - Street 2:SUITE 610
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-5911
Practice Address - Country:US
Practice Address - Phone:334-699-7777
Practice Address - Fax:334-699-7778
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL20398Medicare UPIN