MEDICARE: DR. HATTAN DAMANHOURI

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	122300000X	Dentist	2901022077	MI
2	1223P0700X	Prosthodontics	2901022077	MI

General Provider Information

NPI Number	:	1588111397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HATTAN DAMANHOURI

Provider Business Mailing Address
First Line	:	780 TOWN CENTER DR APT L121
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-3870
Country	:	US
Telephone Number	:	202-730-5445
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 W PIERSON RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48504-6802
Country	:	US
Telephone Number	:	810-789-5880
Fax Number	:

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

Provider Enumeration Date	:	09/09/2016
Last Update Date	:	01/07/2026

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