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General NPI Number Information
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NPI Number | 1023107166
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Entity Type | Individual
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Provider Name | AMIRA A HASSAN D.D.S
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 3280 W 3500 S STE 3
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City | WEST VALLEY
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State | UT
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Zip | 84119-2688
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Country | US
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Telephone | 801-969-2121
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Fax | 801-969-9905
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Provider Business Mailing Address
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Address Line | 3280 W 3500 S #3
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City | WEST VALLEY
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State | UT
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Zip | 84119
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Country | US
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Telephone | 801-969-2121
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Fax | 801-969-9905
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6937199-9921
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 47780
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License Number State | MD
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