Provider Demographics
NPI:1265291256
Name:HASAN, MARIUM (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIUM
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2869 MOUNT DANA DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4894
Mailing Address - Country:US
Mailing Address - Phone:925-888-9363
Mailing Address - Fax:
Practice Address - Street 1:2869 MOUNT DANA DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-4894
Practice Address - Country:US
Practice Address - Phone:925-888-9363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109874122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist