Provider Demographics
NPI:1881205599
Name:HASSAN, SULMAAN (DDS)
Entity Type:Individual
Prefix:
First Name:SULMAAN
Middle Name:
Last Name:HASSAN
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 1:13893 LYNDE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-5310
Mailing Address - Country:US
Mailing Address - Phone:408-621-6773
Mailing Address - Fax:
Practice Address - Street 1:12880 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:BOULDER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95006-9114
Practice Address - Country:US
Practice Address - Phone:408-621-6773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist