Individual provider Active NPI

Mais Abdulmajeed Hassan Al Dahan, DDS

  • Dentist
  • Corona, CA
National Provider Identifier
1114493343
Registry record updated Aug 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12247 Issued in TN
Practice address
3190 Timberline Dr
Corona, CA 92882-8711
Phone
(213) 292-2191
NPI assigned
Oct 15, 2018
Last updated
Aug 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DDS102896 CA
Dentist 122300000X 12247 TN Primary

Addresses

Primary practice location

3190 Timberline Dr
Corona, CA 92882-8711

Mailing address

3190 Timberline Dr
Corona, CA 92882-8711
Phone (213) 292-2191

Other practice location 1

910 E Ohio Ave
Escondido, CA 92025-3438
Phone (760) 737-6935

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241025000474 PA Practitioner - Dentist 2769915008 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DDS102896CAMDDentist
12247TNMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Oct 14, 2024 Accepting new patients
Geisinger Clinic CurrentSince Oct 14, 2024 Accepting new patients
Geisinger Clinic Past Accepting new patients
Hsieh and Abdelkarim Dental Corporation Past Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1539561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756252800000",
    "number": "1114493343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3190 TIMBERLINE DR",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928828711",
            "telephone_number": "213-292-2191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3190 TIMBERLINE DR",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928828711",
            "telephone_number": "213-292-2191"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "910 E Ohio Ave",
            "address_purpose": "LOCATION",
            "city": "Escondido",
            "state": "CA",
            "postal_code": "920253438",
            "country_code": "US",
            "telephone_number": "760-737-6935",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AL DAHAN",
        "first_name": "MAIS",
        "middle_name": "ABDULMAJEED HASSAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-15",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS102896",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "12247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, CA

Sources for this page

Verify at the official NPI Registry.