Provider Demographics
NPI:1669632824
Name:HUSSAIN, HENNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENNA
Middle Name:
Last Name:HUSSAIN
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 1:3417 KEARNY VILLA LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1912
Mailing Address - Country:US
Mailing Address - Phone:516-384-0898
Mailing Address - Fax:
Practice Address - Street 1:1333 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3520
Practice Address - Country:US
Practice Address - Phone:619-260-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA603441223G0001X
IL0190282011223G0001X
NY054445-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice