Provider Demographics
NPI:1023419033
Name:HIJAZI, MAEN (DMD)
Entity type:Individual
Prefix:DR
First Name:MAEN
Middle Name:
Last Name:HIJAZI
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 1:2810 W CHARLESTON BLVD
Mailing Address - Street 2:UNITE F # 56
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1921
Mailing Address - Country:US
Mailing Address - Phone:702-279-8129
Mailing Address - Fax:
Practice Address - Street 1:2810 W CHARLESTON BLVD
Practice Address - Street 2:UNITE F # 56
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1921
Practice Address - Country:US
Practice Address - Phone:702-279-8129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist