Healthcare Provider Details

I. General information

NPI: 1750169249
Provider Name (Legal Business Name): HASSAN MARWAN MOHAMMED SALIH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HASSAN MARWAN MOHAMMED SALIH HASSAN MARWAN

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 02/11/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 JOHNSON FERRY RD NE UNIT 2A
BROOKHAVEN GA
30319-2203
US

IV. Provider business mailing address

6765 CROFTON DR
ALPHARETTA GA
30005-8358
US

V. Phone/Fax

Practice location:
  • Phone: 404-200-7341
  • Fax:
Mailing address:
  • Phone: 678-640-2871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN123518
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number04869
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: