MEDICARE: HASSAN A ABDEL-MOETI DMD 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	332BC3200X	Customized Equipment (DME)
2	122300000X	Dentist	DN013813	GA

General Provider Information

NPI Number	:	1992101539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HASSAN A ABDEL-MOETI DMD PC

Provider Business Mailing Address
First Line	:	5500 LILBURN STONE MOUNTAIN RD STE A
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-2873
Country	:	US
Telephone Number	:	770-923-5500
Fax Number	:	770-559-9295

Provider Business Practice Location Address
First Line	:	5500 LILBURN STONE MOUNTAIN RD STE A
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-2873
Country	:	US
Telephone Number	:	770-923-5500
Fax Number	:	770-559-9295

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HASSAN MOETI
Credential	:
Telephone Number	:	770-923-5500

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	11/10/2014

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