MEDICARE: HASSNEN FAKHRULDDIN

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	122300000X	Dentist	40117	TX

General Provider Information

NPI Number	:	1639879364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HASSNEN FAKHRULDDIN

Provider Business Mailing Address
First Line	:	10510 W ALIANA TRACE DR APT 101
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-1138
Country	:	US
Telephone Number	:	832-778-7312
Fax Number	:

Provider Business Practice Location Address
First Line	:	6407 HILLCROFT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-3101
Country	:	US
Telephone Number	:	832-778-7312
Fax Number	:

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

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	11/30/2023

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Directions to “ HASSNEN FAKHRULDDIN ” Practice Location

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