Provider Demographics
NPI:1699153619
Name:HANNA HANANIA DDS,PC
Entity type:Organization
Organization Name:HANNA HANANIA DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTAL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ALLEN-ROARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-897-8554
Mailing Address - Street 1:4319 DALE BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2401
Mailing Address - Country:US
Mailing Address - Phone:703-897-8554
Mailing Address - Fax:703-897-9615
Practice Address - Street 1:4319 DALE BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-2401
Practice Address - Country:US
Practice Address - Phone:703-897-8554
Practice Address - Fax:703-897-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty