Provider Demographics
NPI:1932443975
Name:HASAN, FARAH (DMD, BDS)
Entity Type:Individual
Prefix:DR
First Name:FARAH
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:DMD, BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 GALA CIR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-2013
Mailing Address - Country:US
Mailing Address - Phone:386-679-0371
Mailing Address - Fax:
Practice Address - Street 1:2475 W INTERNATIONAL SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1117
Practice Address - Country:US
Practice Address - Phone:386-252-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN200021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice