Healthcare Provider Details

I. General information

NPI: 1104942234
Provider Name (Legal Business Name): BRIAN LEE HASSE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 LOOP 11
WICHITA FALLS TX
76306-6800
US

IV. Provider business mailing address

2100 CANYON RIDGE DR
WICHITA FALLS TX
76309-2715
US

V. Phone/Fax

Practice location:
  • Phone: 940-855-3435
  • Fax: 940-855-3835
Mailing address:
  • Phone: 940-692-7318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14059
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: