Healthcare Provider Details

I. General information

NPI: 1104202183
Provider Name (Legal Business Name): GEORGE MICHAEL HANKEWYCZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA DENTAL HQS 2817 REILLY RD
FORT BRAGG NC
28310-7302
US

IV. Provider business mailing address

USA DENTAL HQS 2817 REILLY RD
FORT BRAGG NC
28310-7302
US

V. Phone/Fax

Practice location:
  • Phone: 910-643-2196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS040446
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: