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General NPI Number Information
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NPI Number | 1952580912
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Entity Type | Organization
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Legal Business Name | MOHAMED ELHASSANIN DENTAL CORPORATION
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 1901 WATT AVE STE 6
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City | SACRAMENTO
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State | CA
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Zip | 95825-2152
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Country | US
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Telephone | 916-482-2755
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 WATT AVE STE 6
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City | SACRAMENTO
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State | CA
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Zip | 95825-2152
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Country | US
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Telephone | 916-482-2755
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MOHAMED IBRAHIEM ELHASSANIN
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Credential | DDS
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Telephone | 916-256-0158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 52049
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License Number State | CA
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