Healthcare Provider Details

I. General information

NPI: 1093508616
Provider Name (Legal Business Name): HANI HIJAZI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 BALMER ST BLDG 570
HILL AFB UT
84056-5012
US

IV. Provider business mailing address

7321 BALMER ST BLDG 570
HILL AFB UT
84056-5012
US

V. Phone/Fax

Practice location:
  • Phone: 801-586-4161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00206411
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: