MEDICARE: MICHAEL LEE HASSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	6142	NC

General Provider Information

NPI Number	:	1043437825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LEE HASSON DDS

Provider Business Mailing Address
First Line	:	1221 FLORAL PKWY STE 101
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6235
Country	:	US
Telephone Number	:	910-793-0440
Fax Number	:	910-793-0441

Provider Business Practice Location Address
First Line	:	1221 FLORAL PKWY STE 101
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6235
Country	:	US
Telephone Number	:	910-793-0440
Fax Number	:	910-793-0441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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