Provider Demographics
NPI:1689741092
Name:HANASAB, HERSEL (DDS)
Entity type:Individual
Prefix:DR
First Name:HERSEL
Middle Name:
Last Name:HANASAB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12926 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-4953
Mailing Address - Country:US
Mailing Address - Phone:818-785-4422
Mailing Address - Fax:818-785-2414
Practice Address - Street 1:12926 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-4953
Practice Address - Country:US
Practice Address - Phone:818-765-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice