Provider Demographics
NPI:1285319467
Name:HANSIS, TAYLOR ANNA (DMD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:ANNA
Last Name:HANSIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SYCAMORE AVE APT 436
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6719
Mailing Address - Country:US
Mailing Address - Phone:843-455-9544
Mailing Address - Fax:
Practice Address - Street 1:1971 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-7890
Practice Address - Country:US
Practice Address - Phone:843-701-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.10550122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist