Provider Demographics
NPI:1851771588
Name:AL-HUMAIRI, HASANAIN (RDH)
Entity Type:Individual
Prefix:
First Name:HASANAIN
Middle Name:
Last Name:AL-HUMAIRI
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:AJ
Other - Middle Name:
Other - Last Name:AL-HUMAIRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:6520 SW SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1947
Mailing Address - Country:US
Mailing Address - Phone:503-883-3885
Mailing Address - Fax:
Practice Address - Street 1:10535 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4077
Practice Address - Country:US
Practice Address - Phone:503-444-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6763124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist