Provider Demographics
NPI:1639489594
Name:HASAN, MARYAM (DDS)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARYAM
Other - Middle Name:
Other - Last Name:GILANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:9 UNAMI CT
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NY
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-951-0288
Mailing Address - Fax:
Practice Address - Street 1:9 UNAMI CT
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NY
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-951-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02452100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist