Healthcare Provider Details

I. General information

NPI: 1225125446
Provider Name (Legal Business Name): WILLARD HANKINS JR., D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2006
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5509 E SPRING ST
LONG BEACH CA
90808-3736
US

IV. Provider business mailing address

5509 E SPRING ST
LONG BEACH CA
90808-3736
US

V. Phone/Fax

Practice location:
  • Phone: 562-421-8206
  • Fax: 562-497-1885
Mailing address:
  • Phone: 562-421-8206
  • Fax: 562-497-1885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number36552
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number36552
License Number StateCA

VIII. Authorized Official

Name: DR. WILLARD HANKINS JR.
Title or Position: CEO
Credential: DDS
Phone: 562-421-8206