Healthcare Provider Details

I. General information

NPI: 1265765762
Provider Name (Legal Business Name): MOUNA HACHICHOU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 COMO LAKE AVE
COQUITLAM BC
V3J3N2
CA

IV. Provider business mailing address

232 TENTH STREET 14
NEW WEST MINSTER BC
V3M3X9
CA

V. Phone/Fax

Practice location:
  • Phone: 604-939-6111
  • Fax:
Mailing address:
  • Phone: 604-312-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401412108
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: