Provider Demographics
NPI:1588854384
Name:HASSAN, MOHAMED (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:HASSAN
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 E SQUANTUM ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1227
Mailing Address - Country:US
Mailing Address - Phone:617-733-7979
Mailing Address - Fax:
Practice Address - Street 1:858 E SQUANTUM ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-1227
Practice Address - Country:US
Practice Address - Phone:617-733-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics