Provider Demographics
NPI:1417520362
Name:ANBARSERRI, HANEEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:HANEEN
Middle Name:
Last Name:ANBARSERRI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-2499
Mailing Address - Country:US
Mailing Address - Phone:201-994-6117
Mailing Address - Fax:
Practice Address - Street 1:1430 S COMMONS DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-8087
Practice Address - Country:US
Practice Address - Phone:843-712-7308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice