Provider Demographics
NPI:1255657441
Name:HASAN, IQUEBAL (DDS)
Entity type:Individual
Prefix:DR
First Name:IQUEBAL
Middle Name:
Last Name:HASAN
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 1:1851 MACGREGOR DOWNS RO
Mailing Address - Street 2:MAIL STOP #701 ECU SCHOOL OF DENTAL MEDICINE
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-0297
Mailing Address - Country:US
Mailing Address - Phone:252-737-7158
Mailing Address - Fax:252-737-7049
Practice Address - Street 1:1851 MACGREGOR DOWNS RD
Practice Address - Street 2:MAIL STOP #701
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5925
Practice Address - Country:US
Practice Address - Phone:252-737-7158
Practice Address - Fax:252-737-7049
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00175122300000X, 1223G0001X, 125Q00000X
NC0175125Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125Q00000XDental ProvidersDentistOral Medicine
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100301160Medicaid