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General NPI Number Information
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NPI Number | 1255657441
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Entity Type | Individual
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Provider Name | IQUEBAL HASAN DDS
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Gender | Male
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 1851 MACGREGOR DOWNS RD MAIL STOP #701
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City | GREENVILLE
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State | NC
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Zip | 27834-5925
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Country | US
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Telephone | 252-737-7158
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Fax | 252-737-7049
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Provider Business Mailing Address
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Address Line | 1851 MACGREGOR DOWNS RO MAIL STOP #701 ECU SCHOOL OF DENTAL MEDICINE
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City | GREENVILLE
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State | NC
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Zip | 27834-0297
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Country | US
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Telephone | 252-737-7158
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Fax | 252-737-7049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 00175
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 00175
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 125Q00000X
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Taxonomy Name | Oral Medicine Dentistry
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License Number | 0175
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 125Q00000X
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Taxonomy Name | Oral Medicine Dentistry
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License Number | 00175
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License Number State | NC
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