Provider Demographics
NPI:1508504960
Name:BASHER, HANNAN SAYADA (DMD)
Entity Type:Individual
Prefix:
First Name:HANNAN
Middle Name:SAYADA
Last Name:BASHER
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 1:414 TREMONT ST APT 72
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-6325
Mailing Address - Country:US
Mailing Address - Phone:347-807-7118
Mailing Address - Fax:
Practice Address - Street 1:315 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-1414
Practice Address - Country:US
Practice Address - Phone:617-524-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18594281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice