Provider Demographics
NPI:1750584546
Name:OTHMAN, HASAN FAWWAZ (DDS, MS, PHD)
Entity type:Individual
Prefix:DR
First Name:HASAN
Middle Name:FAWWAZ
Last Name:OTHMAN
Suffix:
Gender:M
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2340 S HIGHLAND AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5371
Mailing Address - Country:US
Mailing Address - Phone:630-424-9070
Mailing Address - Fax:630-424-9077
Practice Address - Street 1:2340 S HIGHLAND AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5371
Practice Address - Country:US
Practice Address - Phone:630-424-9070
Practice Address - Fax:630-424-9077
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics