1174658363 NPI number — DR. HIKMAT GABRIEL HANNAWI D.M.D

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174658363 NPI number — DR. HIKMAT GABRIEL HANNAWI D.M.D

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HANNAWI

Provider First Name:

HIKMAT

Provider Middle Name:

GABRIEL

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

D.M.D

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1174658363

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/19/2009

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

550 N MAIN ST

Provider Second Line Business Mailing Address:

SUITE # 1

Provider Business Mailing Address City Name:

ATTLEBORO

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

02703-1735

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

508-222-2510

Provider Business Mailing Address Fax Number:

508-222-3903

Provider First Line Business Practice Location Address:

550 N MAIN ST

Provider Second Line Business Practice Location Address:

SUITE #1

Provider Business Practice Location Address City Name:

ATTLEBORO

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

02703-1735

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

508-222-2510

Provider Business Practice Location Address Fax Number:

508-222-3903

Provider Enumeration Date:

02/21/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 1223G0001X , with the licence number:  19763 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: DELTA DENTAL OF MASS . This is a "19763" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: NUICARE . This is a "19763" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: BCBS OF MASS . This is a "HAX 11292" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: BCBS PPO . This is a "V05219" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: GUARDIAN . This is a "043539003" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 0299961 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: ALTUS DENTAL . This is a "19763" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: CIGNA PPO . This is a "19763" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: METLIFE . This is a "19763" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: AETNA PPO . This is a "043539003" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: BCBS OF RI . This is a "MOOOX11292" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: DHA . This is a "89461" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".