Healthcare Provider Details

I. General information

NPI: 1649225962
Provider Name (Legal Business Name): PATRICK C. HANN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 TOUHY AVE STE 402
SKOKIE IL
60077-3227
US

IV. Provider business mailing address

5550 TOUHY AVE STE 402
SKOKIE IL
60077-3227
US

V. Phone/Fax

Practice location:
  • Phone: 773-631-5788
  • Fax: 847-423-2939
Mailing address:
  • Phone: 773-631-5788
  • Fax: 847-423-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19015994
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19015994
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: