Provider Demographics
NPI:1366872467
Name:HASSAN, MUYEENUL (MSD)
Entity type:Individual
Prefix:
First Name:MUYEENUL
Middle Name:
Last Name:HASSAN
Suffix:
Gender:M
Credentials:MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8640 E STATE ROAD 70 STE D
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-3785
Mailing Address - Country:US
Mailing Address - Phone:941-462-3706
Mailing Address - Fax:
Practice Address - Street 1:8640 E STATE ROAD 70 STE D
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3785
Practice Address - Country:US
Practice Address - Phone:941-462-3706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010211301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics