Individual
SEYEDEH ZAHRA HASSANTASH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11415 LEGACY TER, SAN DIEGO, CA 92131-3579
(626) 589-6025
Mailing address
1800 JONATHAN WAY APT 723, RESTON, VA 20190-3693
(626) 589-6025
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401415845
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
102304
CA
Other
Enumeration date
02/25/2018
Last updated
10/01/2019
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