Healthcare Provider Details

I. General information

NPI: 1285545251
Provider Name (Legal Business Name): IBRAHIM HASSAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W 5TH ST
RENO NV
89503-4313
US

IV. Provider business mailing address

905 W 5TH ST
RENO NV
89503-4313
US

V. Phone/Fax

Practice location:
  • Phone: 775-467-2721
  • Fax: 775-467-2413
Mailing address:
  • Phone: 775-467-2721
  • Fax: 775-467-2413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8493
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: