Provider Demographics
NPI:1235507799
Name:AMIRA HASSAN PC
Entity type:Organization
Organization Name:AMIRA HASSAN PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIRA
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-452-4661
Mailing Address - Street 1:3724 JEFFERSON ST
Mailing Address - Street 2:#100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6225
Mailing Address - Country:US
Mailing Address - Phone:512-452-4661
Mailing Address - Fax:512-452-2999
Practice Address - Street 1:3724 JEFFERSON ST
Practice Address - Street 2:#100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6225
Practice Address - Country:US
Practice Address - Phone:512-452-4661
Practice Address - Fax:512-452-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty