Provider Demographics
NPI:1942739693
Name:HASSOUNA, OMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:HASSOUNA
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 1:52 SANDFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:ON
Mailing Address - Zip Code:M3B2B7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4443 CANDLEWOOD ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1736
Practice Address - Country:US
Practice Address - Phone:562-634-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA103076122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program