Provider Demographics
NPI:1801142880
Name:SYED, HASAN ALI (DMD)
Entity type:Individual
Prefix:DR
First Name:HASAN
Middle Name:ALI
Last Name:SYED
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 1:3955 HARRISON RD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8502
Mailing Address - Country:US
Mailing Address - Phone:770-466-0580
Mailing Address - Fax:
Practice Address - Street 1:3955 HARRISON RD STE 400
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8502
Practice Address - Country:US
Practice Address - Phone:770-466-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014452122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist