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General NPI Number Information
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NPI Number | 1386535656
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Entity Type | Individual
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Provider Name | SHAHERYAR HASAN DMD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 900 E FLORENCE BLVD STE D
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City | CASA GRANDE
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State | AZ
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Zip | 85122-4673
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Country | US
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Telephone | 520-836-5468
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Fax |
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Provider Business Mailing Address
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Address Line | 5003 E RIVULON BLVD #3003
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City | GILBERT
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State | AZ
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Zip | 85295
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Country | US
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Telephone |
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D012497
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License Number State | AZ
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