Provider Demographics
NPI:1548660475
Name:HASSAN, MOHAMED (DMD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:HASSAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WISE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-4943
Mailing Address - Country:US
Mailing Address - Phone:410-288-1162
Mailing Address - Fax:443-219-3078
Practice Address - Street 1:201 WISE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-4943
Practice Address - Country:US
Practice Address - Phone:410-288-1162
Practice Address - Fax:443-219-3078
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD157171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice