Provider Demographics
NPI:1548365067
Name:HASSAN, MOHAMED AMIN (DDS, MS)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:AMIN
Last Name:HASSAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12900 PERRIS BLVD
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4135
Mailing Address - Country:US
Mailing Address - Phone:951-242-4944
Mailing Address - Fax:951-242-8668
Practice Address - Street 1:12900 PERRIS BLVD
Practice Address - Street 2:SUITE # 102
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4135
Practice Address - Country:US
Practice Address - Phone:951-242-4944
Practice Address - Fax:951-242-8668
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433451223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics