Organization
FHASAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FARAH HASAN (OWNER)
(386) 233-3040
Entity
Organization
Contact information
Practice address
1812 DUNLAWTON AVE STE 101, PORT ORANGE, FL 32127-2925
(386) 233-3040
Mailing address
PO BOX 70887, CLEVELAND, OH 44190-0887
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/16/2021
Last updated
06/20/2023
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