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General NPI Number Information
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NPI Number | 1366872467
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Entity Type | Individual
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Provider Name | MUYEENUL HASSAN M.S.D.
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Gender | Male
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Dates
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Enumeration Date | 11/26/2013
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 8640 E STATE ROAD 70 STE D
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City | BRADENTON
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State | FL
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Zip | 34202-3785
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Country | US
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Telephone | 941-462-3706
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Fax |
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Provider Business Mailing Address
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Address Line | 8640 E STATE ROAD 70 STE D
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City | BRADENTON
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State | FL
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Zip | 34202-3785
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Country | US
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Telephone | 941-462-3706
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Fax |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2901021130
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License Number State | MI
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