Provider Demographics
NPI:1790217727
Name:HASANAT, WATRAAT (DDS, MSD)
Entity type:Individual
Prefix:
First Name:WATRAAT
Middle Name:
Last Name:HASANAT
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-7351
Mailing Address - Country:US
Mailing Address - Phone:321-208-7979
Mailing Address - Fax:
Practice Address - Street 1:330 N BABCOCK ST STE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7324
Practice Address - Country:US
Practice Address - Phone:321-208-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN264511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics