Provider Demographics
NPI:1528635612
Name:TAW, HANNAH GRACE (DMD)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:GRACE
Last Name:TAW
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 1:10105 JOHN ASHLEY CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-5867
Mailing Address - Country:US
Mailing Address - Phone:901-355-9445
Mailing Address - Fax:
Practice Address - Street 1:1231 GEORGE TOWNE DR STE D
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2756
Practice Address - Country:US
Practice Address - Phone:262-691-9832
Practice Address - Fax:262-691-9871
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001033-15122300000X, 1223G0001X
KY10584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist