Provider Demographics
NPI:1164551792
Name:HASSAN, WILLIAM MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:HASSAN
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 K
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:12117
Mailing Address - Country:US
Mailing Address - Phone:518-661-6405
Mailing Address - Fax:518-661-7765
Practice Address - Street 1:2540 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:NY
Practice Address - Zip Code:12117
Practice Address - Country:US
Practice Address - Phone:518-661-6405
Practice Address - Fax:518-661-7765
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04005411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice