Provider Demographics
NPI:1639293996
Name:HASAN, SYED M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:M
Last Name:HASAN
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 1:165 E HIGH ST
Mailing Address - Street 2:101
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1151
Mailing Address - Country:US
Mailing Address - Phone:805-529-2400
Mailing Address - Fax:
Practice Address - Street 1:165 E HIGH ST
Practice Address - Street 2:101
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1151
Practice Address - Country:US
Practice Address - Phone:805-529-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice