Provider Demographics
NPI:1801419023
Name:ELHUSSEIN, HAMMAD A (BDS)
Entity Type:Individual
Prefix:
First Name:HAMMAD
Middle Name:A
Last Name:ELHUSSEIN
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5395
Mailing Address - Country:US
Mailing Address - Phone:202-820-0300
Mailing Address - Fax:
Practice Address - Street 1:3040 SW 27TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8914
Practice Address - Country:US
Practice Address - Phone:352-433-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2022-11-08
Deactivation Date:2020-09-28
Deactivation Code:
Reactivation Date:2020-11-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No124Q00000XDental ProvidersDental Hygienist