1386894715 NPI number — DR. HAJAR FATIHAH HASAN-VERRETT DDS

Table of content: DR. HAJAR FATIHAH HASAN-VERRETT DDS (NPI 1386894715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386894715 NPI number — DR. HAJAR FATIHAH HASAN-VERRETT DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASAN-VERRETT
Provider First Name:
HAJAR
Provider Middle Name:
FATIHAH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HASAN-VERRETT
Provider Other First Name:
HAJAR
Provider Other Middle Name:
FATIHAH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1386894715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2056 NE 167TH ST APT 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33162-6217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-812-6321
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3058 NW 79TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33147-4706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-696-9999
Provider Business Practice Location Address Fax Number:
305-696-2050
Provider Enumeration Date:
09/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DN18479 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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