MEDICARE: SYED K HASSAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019.032141	IL

General Provider Information

NPI Number	:	1801454210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYED K HASSAN DDS

Provider Business Mailing Address
First Line	:	4010 MONROE ST APT 101
Second Line	:
City	:	BELLWOOD
State	:	IL
Zip	:	60104-2078
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13442 CICERO AVE
Second Line	:
City	:	CRESTWOOD
State	:	IL
Zip	:	60418-1430
Country	:	US
Telephone Number	:	708-571-0308
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2019
Last Update Date	:	05/31/2019

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