Provider Demographics
NPI:1205612140
Name:HANOIAN, ALISHA KAREN (RDH)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:KAREN
Last Name:HANOIAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3185 MANTLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-6616
Mailing Address - Country:US
Mailing Address - Phone:508-254-2716
Mailing Address - Fax:
Practice Address - Street 1:3185 MANTLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-6616
Practice Address - Country:US
Practice Address - Phone:508-254-2716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13154124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist