MEDICARE: NADDER M HASSAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1134782733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NADDER M HASSAN DDS

Provider Business Mailing Address
First Line	:	11490 COMMERCE PARK DR STE 110
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-1532
Country	:	US
Telephone Number	:	804-912-6733
Fax Number	:

Provider Business Practice Location Address
First Line	:	11490 COMMERCE PARK DR STE 110
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-1532
Country	:	US
Telephone Number	:	804-912-6733
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	NADDER HASSAN
Credential	:	DDS
Telephone Number	:	703-335-1020

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	04/18/2019

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Directions to “NADDER M HASSAN DDS ” Practice Location

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