Provider Demographics
NPI:1275612368
Name:HASNAIN, BAQAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BAQAR
Middle Name:
Last Name:HASNAIN
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 1:101 MAYO ST STE A
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3696
Mailing Address - Country:US
Mailing Address - Phone:229-924-4647
Mailing Address - Fax:
Practice Address - Street 1:101 MAYO ST STE A
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3696
Practice Address - Country:US
Practice Address - Phone:229-924-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0131701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA516756947AMedicaid