Provider Demographics
NPI:1811663560
Name:HASSANEIN, MOHAMED (DMD, MS)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:HASSANEIN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 ARBORETUM DR APT 301
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-6296
Mailing Address - Country:US
Mailing Address - Phone:330-631-3094
Mailing Address - Fax:
Practice Address - Street 1:113 SMITH AVE UNIT 5
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4756
Practice Address - Country:US
Practice Address - Phone:980-296-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC124581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice