Healthcare Provider Details

I. General information

NPI: 1124509468
Provider Name (Legal Business Name): DR. HADJIR HAGHPARAST HASSAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5122 OLYMPIC DR NW SUITE B101
GIG HARBOR WA
98335
US

IV. Provider business mailing address

8 ROSEAPPLE RD
RANCHO PALOS VERDES CA
90275
US

V. Phone/Fax

Practice location:
  • Phone: 253-851-5544
  • Fax:
Mailing address:
  • Phone: 310-357-9343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60857316
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number60857316
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: