Provider Demographics
NPI:1043768773
Name:HASSAN, NATHANIEL
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:
Last Name:HASSAN
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 1:18500 VIA PRINCESSA STE 1
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-8325
Mailing Address - Country:US
Mailing Address - Phone:661-298-1100
Mailing Address - Fax:661-298-1108
Practice Address - Street 1:38209 47TH ST E STE E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-3113
Practice Address - Country:US
Practice Address - Phone:661-236-0046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100796122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist