Healthcare Provider Details

I. General information

NPI: 1306964374
Provider Name (Legal Business Name): JOHN JOSEPH HANKS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 FIVE MILE ROAD NE SUITE 101
GRAND RAPIDS MI
49525-6518
US

IV. Provider business mailing address

2730 FIVE MILE ROAD NE SUITE 101
GRAND RAPIDS MI
49525-6518
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-7039
  • Fax: 616-364-6068
Mailing address:
  • Phone: 616-364-7039
  • Fax: 616-364-6068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD11563
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: