Hassan M. Dezham, DDS
Individual provider Active NPI Dentist · Sacramento, CA
NPI 1700920824 · NPPES record last updated Jan 13, 2020
Key facts
- NPI
- 1700920824
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 52801 (CA)
- Practice address
- 3009 K St Ste 255
Sacramento, CA 95816-5252 - Phone
- (916) 441-3311
- Fax
- (916) 441-0630
- NPI assigned
- Feb 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160405002526 | CA | Order and Referring Only - Dentist |
0446558555 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18793 | TX | MD | Professional Counselor |
| 52801 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A Miracle Smile by Dr. Dezham Dental Group Inc. | Dentist | Current |
Accepting new patients |
| A Miracle Smile by Dr. Dezham Dental Group | Dentist | Past | Accepting new patients |
| Smiley Dental Sheperd PLLC | Past | Accepting new patients |
Locations
3009 K St
Ste 255
Sacramento, CA 95816
Phone (916) 441-3311
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 52801 | CA | Yes |
Addresses
Primary practice location
3009 K St Ste 255
Sacramento, CA 95816-5252
Mailing address
3009 K St Ste 255
Sacramento, CA 95816-5252
Phone (916) 441-3311
Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.