MEDICARE: BRANDON HANNA DMD, INC.

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1790596658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANDON HANNA DMD, INC.

Provider Business Mailing Address
First Line	:	1035 HARBISON AVE STE A
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-3919
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 HARBISON AVE STE A
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-3919
Country	:	US
Telephone Number	:	619-472-0400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRANDON HANNA
Credential	:	DMD
Telephone Number	:	619-475-2395

Provider Enumeration Date	:	01/18/2025
Last Update Date	:	01/18/2025

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