Healthcare Provider Details

I. General information

NPI: 1053246124
Provider Name (Legal Business Name): HASSAN BEYDOUN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13761 N LITCHFIELD RD STE 103
SURPRISE AZ
85379-4272
US

IV. Provider business mailing address

15603 W HACKAMORE DR
SURPRISE AZ
85387-7377
US

V. Phone/Fax

Practice location:
  • Phone: 623-975-3933
  • Fax:
Mailing address:
  • Phone: 313-627-8356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012872
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: