Provider Demographics
NPI:1922824259
Name:HASSAN, SYED FAZEEL (DMD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:FAZEEL
Last Name:HASSAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 NW 91ST TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-5529
Mailing Address - Country:US
Mailing Address - Phone:352-213-4172
Mailing Address - Fax:
Practice Address - Street 1:2154 GOODMAN RD W # 1
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1303
Practice Address - Country:US
Practice Address - Phone:662-393-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1111671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice