Provider Demographics
NPI:1063954139
Name:HASME, ABU FAISAL MOHAMMAD (DDS)
Entity type:Individual
Prefix:
First Name:ABU FAISAL
Middle Name:MOHAMMAD
Last Name:HASME
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-1060
Mailing Address - Country:US
Mailing Address - Phone:870-448-5101
Mailing Address - Fax:870-448-3767
Practice Address - Street 1:465 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-7946
Practice Address - Country:US
Practice Address - Phone:501-745-8811
Practice Address - Fax:501-745-5042
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR221694608Medicaid