Provider Demographics
NPI:1659158863
Name:AL KHUZAE, HASAN HAIRTH KHALID (DDS)
Entity Type:Individual
Prefix:DR
First Name:HASAN
Middle Name:HAIRTH KHALID
Last Name:AL KHUZAE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23031 S WATERLILY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-8623
Mailing Address - Country:US
Mailing Address - Phone:128-143-5685
Mailing Address - Fax:
Practice Address - Street 1:31960 MISSION TRL
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4539
Practice Address - Country:US
Practice Address - Phone:951-643-6099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist