Healthcare Provider Details

I. General information

NPI: 1467946541
Provider Name (Legal Business Name): WAEL AMGAD REFAAT AHMED HASSAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ASPEN DENTAL 791 TURNER STREET
AUBURN ME
04210
US

IV. Provider business mailing address

791 TURNER STREET
AUBURN ME
04210
US

V. Phone/Fax

Practice location:
  • Phone: 207-558-0085
  • Fax: 207-753-0594
Mailing address:
  • Phone: 207-558-0085
  • Fax: 207-753-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN4624
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: