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General NPI Number Information
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NPI Number | 1588111397
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Entity Type | Individual
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Provider Name | DR. HATTAN DAMANHOURI
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Gender | Male
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 2501 W PIERSON RD
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City | FLINT
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State | MI
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Zip | 48504-6802
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Country | US
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Telephone | 810-789-5880
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Fax |
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Provider Business Mailing Address
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Address Line | 780 TOWN CENTER DR APT L121
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City | DEARBORN
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State | MI
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Zip | 48126-3870
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Country | US
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Telephone | 202-730-5445
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 2901022077
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901022077
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License Number State | MI
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