Provider Demographics
NPI:1457615676
Name:SULTAN, HASSAM CHAUHDRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:HASSAM
Middle Name:CHAUHDRY
Last Name:SULTAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 W PASSAIC AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5552
Mailing Address - Country:US
Mailing Address - Phone:973-338-1383
Mailing Address - Fax:973-338-8113
Practice Address - Street 1:382 W PASSAIC AVE FL 2
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5552
Practice Address - Country:US
Practice Address - Phone:973-338-1383
Practice Address - Fax:973-338-8113
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0583061223P0221X
CT0108881223P0221X, 122300000X
NJ22DI025679001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0053158OtherCDS
NJD10408300OtherCDS