Healthcare Provider Details

I. General information

NPI: 1124633151
Provider Name (Legal Business Name): SULMAAN HASSAN DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12880 HIGHWAY 9
BOULDER CREEK CA
95006-9114
US

IV. Provider business mailing address

13893 LYNDE AVE
SARATOGA CA
95070-5310
US

V. Phone/Fax

Practice location:
  • Phone: 831-338-1888
  • Fax:
Mailing address:
  • Phone: 408-621-6773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SULMAAN HASSAN
Title or Position: CEO
Credential: DDS
Phone: 408-621-6773