MEDICARE: MAHA HANNA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	42543	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B42543-03	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1205022431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHA HANNA D.D.S.

Provider Business Mailing Address
First Line	:	6616 CHERRY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-1715
Country	:	US
Telephone Number	:	562-630-2262
Fax Number	:

Provider Business Practice Location Address
First Line	:	6616 CHERRY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-1715
Country	:	US
Telephone Number	:	562-630-2262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	09/21/2007

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Directions to “ MAHA HANNA D.D.S.” Practice Location

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