Provider Demographics
NPI:1720833098
Name:HASSON, DALLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:
Last Name:HASSON
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 1:8200 ROBERTS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4150
Mailing Address - Country:US
Mailing Address - Phone:770-504-4519
Mailing Address - Fax:
Practice Address - Street 1:2855 LAWRENCEVILLE SUWANEE RD STE 360
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3596
Practice Address - Country:US
Practice Address - Phone:678-482-2197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-20
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist