Provider Demographics
NPI:1699929166
Name:HAHN, DERICK (DDS)
Entity type:Individual
Prefix:
First Name:DERICK
Middle Name:
Last Name:HAHN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S 43RD ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5404
Mailing Address - Country:US
Mailing Address - Phone:425-226-9270
Mailing Address - Fax:425-254-1129
Practice Address - Street 1:401 S 43RD ST
Practice Address - Street 2:SUITE 250
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5404
Practice Address - Country:US
Practice Address - Phone:425-226-9270
Practice Address - Fax:425-254-1129
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600359321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice