Provider Demographics
NPI:1265765762
Name:HACHICHOU, MOUNA (DMD)
Entity type:Individual
Prefix:DR
First Name:MOUNA
Middle Name:
Last Name:HACHICHOU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 TENTH STREET
Mailing Address - Street 2:14
Mailing Address - City:NEW WEST MINSTER
Mailing Address - State:BC
Mailing Address - Zip Code:V3M3X9
Mailing Address - Country:CA
Mailing Address - Phone:604-312-3737
Mailing Address - Fax:
Practice Address - Street 1:949 COMO LAKE AVE
Practice Address - Street 2:
Practice Address - City:COQUITLAM
Practice Address - State:BC
Practice Address - Zip Code:V3J3N2
Practice Address - Country:CA
Practice Address - Phone:604-939-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014121081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice