1467946541 NPI number — DR. WAEL AMGAD REFAAT AHMED HASSAN DDS

Table of content: DR. WAEL AMGAD REFAAT AHMED HASSAN DDS (NPI 1467946541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467946541 NPI number — DR. WAEL AMGAD REFAAT AHMED HASSAN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASSAN
Provider First Name:
WAEL
Provider Middle Name:
AMGAD REFAAT AHMED
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1467946541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
791 TURNER STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-558-0085
Provider Business Mailing Address Fax Number:
207-753-0594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ASPEN DENTAL
Provider Second Line Business Practice Location Address:
791 TURNER STREET
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-558-0085
Provider Business Practice Location Address Fax Number:
207-753-0594
Provider Enumeration Date:
06/21/2018

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: DEN4624 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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