Provider Demographics
NPI:1265977029
Name:BAZZI, HASSAN I (DDS)
Entity type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:I
Last Name:BAZZI
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 1:26540 RICHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1925
Mailing Address - Country:US
Mailing Address - Phone:313-903-1167
Mailing Address - Fax:
Practice Address - Street 1:5211 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3229
Practice Address - Country:US
Practice Address - Phone:313-581-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist