Healthcare Provider Details

I. General information

NPI: 1760167209
Provider Name (Legal Business Name): FADIA S HANNA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13403 E 13 MILE RD
WARREN MI
48088-3188
US

IV. Provider business mailing address

13403 E 13 MILE RD
WARREN MI
48088-3188
US

V. Phone/Fax

Practice location:
  • Phone: 586-979-2800
  • Fax:
Mailing address:
  • Phone: 586-979-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901601797
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: