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General NPI Number Information
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NPI Number | 1366649188
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Entity Type | Organization
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Legal Business Name | BROOKFIELDFAMILYDENTALART
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 2 OLD NEW MILFORD ROAD SUITE 3 A
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City | BROOKFIELD
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State | CT
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Zip | 06804
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Country | US
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Telephone | 203-740-1014
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Fax | 203-740-1016
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Provider Business Mailing Address
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Address Line | 2 OLD NEW MILFORD ROAD SUITE 3 A
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City | BROOKFIELD
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State | CT
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Zip | 06804
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Country | US
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Telephone | 203-740-1014
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Fax | 203-740-1016
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. RAWA HASSAN
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Credential | DDS
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Telephone | 203-740-1014
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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 | 9194
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License Number State | CT
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