Provider Demographics
NPI:1588111397
Name:DAMANHOURI, HATTAN
Entity type:Individual
Prefix:DR
First Name:HATTAN
Middle Name:
Last Name:DAMANHOURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 TOWN CENTER DR APT L121
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3870
Mailing Address - Country:US
Mailing Address - Phone:202-730-5445
Mailing Address - Fax:
Practice Address - Street 1:2501 W PIERSON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-6802
Practice Address - Country:US
Practice Address - Phone:810-789-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010220771223P0700X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics