=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467612366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAWLAT G. HASSO, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2008
-----------------------------------------------------
Last Update Date | 09/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4139 BALDWIN RD
-----------------------------------------------------
City | AUBURN HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48326-1225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-379-3093
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6323 GLYNDEBOURNE DR
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48098-2212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-379-3093
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. DAWLAT HASSO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 248-379-3093
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2901017711
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------