Provider Demographics
NPI:1013572023
Name:HASAN, AMMAR (DA)
Entity type:Individual
Prefix:
First Name:AMMAR
Middle Name:
Last Name:HASAN
Suffix:
Gender:M
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16820 DUMFRIES RD STE 110
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-2055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16820 DUMFRIES RD STE 110
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-2055
Practice Address - Country:US
Practice Address - Phone:703-232-4938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2025-10-29
Deactivation Date:2021-07-29
Deactivation Code:
Reactivation Date:2025-10-24
Provider Licenses
StateLicense IDTaxonomies
VA04014194781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice