MEDICARE: MANSURY HAWA LTD

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	60133	KS

General Provider Information

NPI Number	:	1871769695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANSURY HAWA LTD

Provider Business Mailing Address
First Line	:	1159 SW RED OAKS PL
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66615-1235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1159 SW RED OAKS PL
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66615-1235
Country	:	US
Telephone Number	:	785-269-9655
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NUSRAT HAWA
Credential	:	DMD
Telephone Number	:	785-269-9655

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/01/2008

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