Provider Demographics
NPI:1336207646
Name:HASHEM, AYMAN ALY (BDS)
Entity Type:Individual
Prefix:
First Name:AYMAN
Middle Name:ALY
Last Name:HASHEM
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27704 LAFAYETTE WAY
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5710
Mailing Address - Country:US
Mailing Address - Phone:951-312-1657
Mailing Address - Fax:951-766-9655
Practice Address - Street 1:25155 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8974
Practice Address - Country:US
Practice Address - Phone:951-834-9751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47087122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist