Provider Demographics
NPI:1265279830
Name:HASSAN, SYEDA MEHREEN (DMD)
Entity type:Individual
Prefix:DR
First Name:SYEDA
Middle Name:MEHREEN
Last Name:HASSAN
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 1:13717 S ROUTE 30 STE 129
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-5516
Mailing Address - Country:US
Mailing Address - Phone:815-676-0244
Mailing Address - Fax:
Practice Address - Street 1:13717 S ROUTE 30 STE 129
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-5516
Practice Address - Country:US
Practice Address - Phone:815-676-0244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0352711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice