MEDICARE: DR. GEORGE EDWARD HANNA DDS

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	1223G0001X	General Practice Dentistry	6776	IA

General Provider Information

NPI Number	:	1568508224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE EDWARD HANNA DDS

Provider Business Mailing Address
First Line	:	3031 CENTER POINT RD NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-4037
Country	:	US
Telephone Number	:	319-364-3221
Fax Number	:	319-364-1860

Provider Business Practice Location Address
First Line	:	3031 CENTER POINT RD NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-4037
Country	:	US
Telephone Number	:	319-364-3221
Fax Number	:	319-364-1860

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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