Provider Demographics
NPI:1619012911
Name:HASSANEIN, JINOUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JINOUS
Middle Name:
Last Name:HASSANEIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2360
Mailing Address - Country:US
Mailing Address - Phone:617-923-8100
Mailing Address - Fax:617-923-0979
Practice Address - Street 1:377 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2360
Practice Address - Country:US
Practice Address - Phone:617-923-8100
Practice Address - Fax:617-923-0979
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist