Provider Demographics
NPI:1225203094
Name:ZANDIEH, HASSAN
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:
Last Name:ZANDIEH
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 1:1718 N 44TH ST
Mailing Address - Street 2:1718 NORTH 44TH STREET
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4125
Mailing Address - Country:US
Mailing Address - Phone:602-273-7111
Mailing Address - Fax:602-273-7113
Practice Address - Street 1:1718 N 44TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4125
Practice Address - Country:US
Practice Address - Phone:602-273-7111
Practice Address - Fax:602-273-7113
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD49551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice