Healthcare Provider Details

I. General information

NPI: 1083327134
Provider Name (Legal Business Name): HAMMOUDA DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 ESTUDILLO AVE
SAN LEANDRO CA
94577-4961
US

IV. Provider business mailing address

1011 RIVERTON DR
SAN CARLOS CA
94070-2509
US

V. Phone/Fax

Practice location:
  • Phone: 510-969-8510
  • Fax:
Mailing address:
  • Phone: 206-679-0348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DINA HAMMOUDA
Title or Position: DENTIST
Credential: DDS MSD
Phone: 206-679-0348