Individual provider Active NPI

MHD Fadi Alhawasli

  • Dentist
  • Palm Bay, FL
National Provider Identifier
1073137303
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN27392 Issued in FL
Practice address
6050 Babcock St SE Ste 2
Palm Bay, FL 32909-4203
Phone
(321) 725-9946
NPI assigned
Jun 2, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN27392 FL Primary

Addresses

Primary practice location

6050 Babcock St SE Ste 2
Palm Bay, FL 32909-4203

Mailing address

6050 Babcock St SE Ste 2
Palm Bay, FL 32909-4203
Phone (248) 808-5724

Other practice location 1

1325 Pine St Ste 103
Melbourne, FL 32901-3189
Phone (321) 724-4520

Other identifiers 1

IdentifierTypeStateIssuer
115693300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN27392FLMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Assaf, Inc Dentist CurrentSince Jun 16, 2024 Accepting new patients
Ray L Pollack & Associates DDS PA Past Accepting new patients

Locations

1325 Pine St
Ste 103
Melbourne, FL 32901
Phone (321) 724-4520

6050 Babcock St SE
Ste 2
Palm Bay, FL 32909
Phone (321) 725-9946

Networks

  • Freedom Health HMO Network

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1073137303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6050 BABCOCK ST SE STE 2",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329094203",
            "telephone_number": "248-808-5724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6050 BABCOCK ST SE STE 2",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329094203",
            "telephone_number": "321-725-9946"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1325 Pine St Ste 103",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329013189",
            "country_code": "US",
            "telephone_number": "321-724-4520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALHAWASLI",
        "first_name": "MHD FADI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-02",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN27392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115693300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.