Healthcare Provider Details

I. General information

NPI: 1457615676
Provider Name (Legal Business Name): HASSAM CHAUHDRY SULTAN DMD,MS,FAAPD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 BROAD ST STE 207
CLIFTON NJ
07013-3346
US

IV. Provider business mailing address

1135 BROAD ST STE 207
CLIFTON NJ
07013-3346
US

V. Phone/Fax

Practice location:
  • Phone: 973-338-1383
  • Fax: 973-338-8113
Mailing address:
  • Phone: 973-338-1383
  • Fax: 973-338-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number010888
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02567900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number058306
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: