Provider Demographics
NPI:1023107166
Name:HASSAN, AMIRA A (DDS)
Entity type:Individual
Prefix:
First Name:AMIRA
Middle Name:A
Last Name:HASSAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 W 3500 S #3
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84119
Mailing Address - Country:US
Mailing Address - Phone:801-969-2121
Mailing Address - Fax:801-969-9905
Practice Address - Street 1:3280 W 3500 S STE 3
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84119-2688
Practice Address - Country:US
Practice Address - Phone:801-969-2121
Practice Address - Fax:801-969-9905
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6937199-9921122300000X
MD477801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice