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General NPI Number Information
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NPI Number | 1104579937
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Entity Type | Organization
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Legal Business Name | WEST SHORE ENDODONTICS, PLLC
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 12228 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-2631
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Country | US
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Telephone | 352-606-2550
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Fax | 352-606-2549
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Provider Business Mailing Address
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Address Line | 12228 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-2631
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Country | US
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Telephone | 352-606-2550
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Fax | 352-606-2549
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Authorized Official
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Title or Position | CONTROLLING MANAGER
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Name | DR. HANNY HAMOUI
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Credential | D.M.D.
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Telephone | 352-606-2550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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