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General NPI Number Information
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NPI Number | 1679139521
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Entity Type | Individual
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Provider Name | OMAR ELHASSADI BDS, FFD, MSC
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Gender | Male
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 844 6TH ST
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City | CLARKSTON
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State | WA
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Zip | 99403
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Country | US
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Telephone | 208-848-8300
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Fax | 208-848-8306
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Provider Business Mailing Address
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Address Line | 611 N IRON BRIDGE WAY
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City | SPOKANE
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State | WA
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Zip | 99202-4932
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Country | US
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Telephone | 509-444-8888
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Fax | 509-444-7806
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60915436
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License Number State | WA
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