MEDICARE: DR. HAJAR FATIHAH HASAN-VERRETT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN18479	FL

General Provider Information

NPI Number	:	1386894715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAJAR FATIHAH HASAN-VERRETT DDS

Provider Business Mailing Address
First Line	:	2056 NE 167TH ST APT 1
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-6217
Country	:	US
Telephone Number	:	305-812-6321
Fax Number	:

Provider Business Practice Location Address
First Line	:	3058 NW 79TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33147-4706
Country	:	US
Telephone Number	:	305-696-9999
Fax Number	:	305-696-2050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2008
Last Update Date	:	03/23/2011

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