Healthcare Provider Details

I. General information

NPI: 1659208742
Provider Name (Legal Business Name): HASEEB ASHFAQ BHATTI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SOUTH DRIVE 114 ROCKLAND HALL
STONY BROOK NY
11794
US

IV. Provider business mailing address

203 BOYKOWICH CRESCENT
SASKATOON SK
S7W053
CA

V. Phone/Fax

Practice location:
  • Phone: 631-632-3181
  • Fax: 631-632-8717
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: