Healthcare Provider Details

I. General information

NPI: 1598529976
Provider Name (Legal Business Name): UMER HASAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3528 S SIGNAL BUTTE RD STE 101
MESA AZ
85212-4229
US

IV. Provider business mailing address

2849 E ATHENA CT
GILBERT AZ
85297-8143
US

V. Phone/Fax

Practice location:
  • Phone: 480-447-6724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD012928
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: