=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588683361
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAY YOUSRY HANNA DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2006
-----------------------------------------------------
Last Update Date | 10/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38 CENTRAL AVE
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02150-3203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-887-1400
-----------------------------------------------------
Fax | 617-887-1401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38 CENTRAL AVE
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02150-3203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-887-1400
-----------------------------------------------------
Fax | 617-887-1401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 19968
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------