Individual
SHAISTA HASAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
29 BEAR CREEK BLVD, WILKES BARRE TOWNSHIP, PA 18702-7803
(570) 825-8090
Mailing address
29 BEAR CREEK BLVD, WILKES BARRE TOWNSHIP, PA 18702-7803
(570) 825-8090
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS042929
PA
Other
Enumeration date
10/02/2020
Last updated
06/15/2021
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