Healthcare Provider Details

I. General information

NPI: 1730853516
Provider Name (Legal Business Name): BRENDA HANES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 LANDMARK DR STE E
LAFAYETTE IN
47905-0002
US

IV. Provider business mailing address

5769 WATERSTONE WAY
WHITESTOWN IN
46075-9001
US

V. Phone/Fax

Practice location:
  • Phone: 765-588-3201
  • Fax:
Mailing address:
  • Phone: 317-354-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number12013585A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: