Provider Demographics
NPI:1982912200
Name:HASSAN DENTISTRY, P.C.
Entity Type:Organization
Organization Name:HASSAN DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:H
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-699-7777
Mailing Address - Street 1:200 GROVE PARK LN
Mailing Address - Street 2:SUITE 610
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-5911
Mailing Address - Country:US
Mailing Address - Phone:334-699-7777
Mailing Address - Fax:334-699-7778
Practice Address - Street 1:200 GROVE PARK LN
Practice Address - Street 2:SUITE 610
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-5911
Practice Address - Country:US
Practice Address - Phone:334-699-7777
Practice Address - Fax:334-699-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5449261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL20398Medicare UPIN