Healthcare Provider Details

I. General information

NPI: 1972027878
Provider Name (Legal Business Name): HANNE DENTAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/21/2022
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: 618-656-9701
Mailing address:
  • Phone: 618-972-8655
  • Fax: 618-656-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.024344
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number015867
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number019.024344
License Number StateIL

VIII. Authorized Official

Name: SHARON HANNE
Title or Position: OWNER
Credential: DMD
Phone: 618-972-8655