Healthcare Provider Details

I. General information

NPI: 1679067060
Provider Name (Legal Business Name): SAMUEL PAUL HANGER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PINCKNEY BLVD
FPO AA
22902
US

IV. Provider business mailing address

21 MERIDIAN RD
BEAUFORT SC
29907-1402
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-5994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00203650
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: