MEDICARE: DAWLAT G. HASSO, DDS, PC

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	2901017711	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467612366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAWLAT G. HASSO, DDS, PC

Provider Business Mailing Address
First Line	:	6323 GLYNDEBOURNE DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48098-2212
Country	:	US
Telephone Number	:	248-379-3093
Fax Number	:

Provider Business Practice Location Address
First Line	:	4139 BALDWIN RD
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-1225
Country	:	US
Telephone Number	:	248-379-3093
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DAWLAT HASSO
Credential	:	DDS
Telephone Number	:	248-379-3093

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	09/15/2014

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