Provider Demographics
NPI:1700920824
Name:DEZHAM, HASSAN M (DDS)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:M
Last Name:DEZHAM
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 1:3009 K ST STE 255
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5252
Mailing Address - Country:US
Mailing Address - Phone:916-441-3311
Mailing Address - Fax:916-441-0630
Practice Address - Street 1:3009 K ST STE 255
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5252
Practice Address - Country:US
Practice Address - Phone:916-441-3311
Practice Address - Fax:916-441-0630
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist