Provider Demographics
NPI:1710188693
Name:HIKMAT J HANNAWI PC
Entity Type:Organization
Organization Name:HIKMAT J HANNAWI PC
Other - Org Name:ATTLEBORO FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HIKMAT
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:HANNAWI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-222-2510
Mailing Address - Street 1:550 N MAIN ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-1735
Mailing Address - Country:US
Mailing Address - Phone:508-222-2510
Mailing Address - Fax:508-222-3903
Practice Address - Street 1:550 N MAIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-1735
Practice Address - Country:US
Practice Address - Phone:508-222-2510
Practice Address - Fax:508-222-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19763122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA19763OtherMETLIFE DENTAL
MA89461OtherDHA
MAMOOOX11292OtherBCBS OF RI
MAHAX 11292OtherBCBS OF MASS
MA0299961Medicaid
MA19763OtherALTUS DENTAL
MA19763OtherCIGNA PPO
MA19763OtherDELTA DENTAL OF MASS
MA19763OtherUNICARE
MA19763OtherGURDIAN DENTAL
MA19763OtherGURDIAN DENTAL