Healthcare Provider Details

I. General information

NPI: 1750137964
Provider Name (Legal Business Name): HAMDAN IBN BASET DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BERGEN ST
NEWARK NJ
07103-2495
US

IV. Provider business mailing address

2 CENTER ST APT 1710
NEWARK NJ
07102-4569
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-3126
  • Fax:
Mailing address:
  • Phone: 727-465-4919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03091000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: