Healthcare Provider Details

I. General information

NPI: 1649317702
Provider Name (Legal Business Name): SHARON E HANNE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 EDWARDSVILLE CROSSING DR STE D
EDWARDSVILLE IL
62025-2708
US

IV. Provider business mailing address

6655 EDWARDSVILLE CROSSING DR STE D
EDWARDSVILLE IL
62025-2708
US

V. Phone/Fax

Practice location:
  • Phone: 618-972-8655
  • Fax: 618-692-6975
Mailing address:
  • Phone: 618-972-8655
  • Fax: 618-692-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.024344
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number015867
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: