MEDICARE: MAHASIN M HANGALAY 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	DEN1000379	DC
2	1223G0001X	General Practice Dentistry	13533	MD
3	1223G0001X	General Practice Dentistry	D6747	AZ

General Provider Information

NPI Number	:	1457342891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHASIN M HANGALAY DDS

Provider Business Mailing Address
First Line	:	822 EAST UNION HILLS DRIVE
Second Line	:	SUITE D6
City	:	PHOENIX
State	:	AZ
Zip	:	85024
Country	:	US
Telephone Number	:	623-582-6789
Fax Number	:	623-780-3344

Provider Business Practice Location Address
First Line	:	822 EAST UNION HILLS DRIVE
Second Line	:	SUITE D6
City	:	PHOENIX
State	:	AZ
Zip	:	85024
Country	:	US
Telephone Number	:	623-582-6789
Fax Number	:	623-780-3344

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	07/27/2007

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