MEDICARE: BASIL HAMMOUDEH D.M.D.

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	1223G0001X	General Practice Dentistry	17461	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477518819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASIL HAMMOUDEH D.M.D.

Provider Business Mailing Address
First Line	:	6452 VINELAND RD UNIT 301
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-7875
Country	:	US
Telephone Number	:	407-929-9495
Fax Number	:

Provider Business Practice Location Address
First Line	:	4307 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-5217
Country	:	US
Telephone Number	:	407-514-0400
Fax Number	:	407-206-3573

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	04/24/2013

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