Provider Demographics
NPI:1073137303
Name:ALHAWASLI, MHD FADI
Entity type:Individual
Prefix:
First Name:MHD FADI
Middle Name:
Last Name:ALHAWASLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 BABCOCK ST SE STE 2
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-4203
Mailing Address - Country:US
Mailing Address - Phone:248-808-5724
Mailing Address - Fax:
Practice Address - Street 1:6050 BABCOCK ST SE STE 2
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-4203
Practice Address - Country:US
Practice Address - Phone:321-725-9946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27392122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115693300Medicaid