Provider Demographics
NPI:1194423814
Name:HANEL, ALYSSA (DDS)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:HANEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 VENICE BLVD APT 417
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-7440
Mailing Address - Country:US
Mailing Address - Phone:973-487-0584
Mailing Address - Fax:
Practice Address - Street 1:7721 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2411
Practice Address - Country:US
Practice Address - Phone:562-632-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1091601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice