Provider Demographics
NPI:1811137383
Name:ABDIRAHMAN, HASSANOOR (DDS)
Entity type:Individual
Prefix:DR
First Name:HASSANOOR
Middle Name:
Last Name:ABDIRAHMAN
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 1:650 N CARRIAGE PKWY STE 60
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4512
Mailing Address - Country:US
Mailing Address - Phone:719-562-4460
Mailing Address - Fax:
Practice Address - Street 1:650 N CARRIAGE PKWY STE 60
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4512
Practice Address - Country:US
Practice Address - Phone:719-562-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist