Healthcare Provider Details

I. General information

NPI: 1982912200
Provider Name (Legal Business Name): HASSAN DENTISTRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GROVE PARK LN SUITE 610
DOTHAN AL
36305-5911
US

IV. Provider business mailing address

200 GROVE PARK LN SUITE 610
DOTHAN AL
36305-5911
US

V. Phone/Fax

Practice location:
  • Phone: 334-699-7777
  • Fax: 334-699-7778
Mailing address:
  • Phone: 334-699-7777
  • Fax: 334-699-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number5449
License Number StateAL

VIII. Authorized Official

Name: DR. MOHAMMED H HASSAN
Title or Position: PRESIDENT/DENTIST
Credential: D.M.D
Phone: 334-699-7777