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DR. HASIM MOMIN D.M.D.

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1013391119

Individual Registrant:
DR. HASIM  MOMIN D.M.D.
Gender: M
Not Sole Proprietor

Location and contact information for practice:
100 MYRTLE BLVD  GRACEWOOD, GA 30812 US
Tel: 706-790-2144  Fax: --

Contact information for business:
100 MYRTLE BLVD  GRACEWOOD, GA 30812 US
Tel: 706-790-2144  Fax: --

Registration Information:
NPI: 1013391119
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N1223G0001XDental Providers
Dentist
General Practice
SCDGD.8645 GD
Y1223G0001XDental Providers
Dentist
GADN015041

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
003181901AGA05




HEALTH CARE JOBS GA - Page 1



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