Provider Demographics
NPI:1598865867
Name:HASSAN, RAWA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAWA
Middle Name:M
Last Name:HASSAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 OLD NEW MILFORD RD
Mailing Address - Street 2:3 A
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2426
Mailing Address - Country:US
Mailing Address - Phone:203-740-1014
Mailing Address - Fax:203-740-1016
Practice Address - Street 1:2 OLD NEW MILFORD RD
Practice Address - Street 2:3 A
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2426
Practice Address - Country:US
Practice Address - Phone:203-740-1014
Practice Address - Fax:203-740-1016
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT91941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice