Healthcare Provider Details

I. General information

NPI: 1720320138
Provider Name (Legal Business Name): EMILY E HAHN D.M.D, M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2013
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14801 ASPEN LN APT G
WATERTOWN NY
13601-6048
US

IV. Provider business mailing address

14801 ASPEN LN APT G
WATERTOWN NY
13601-6049
US

V. Phone/Fax

Practice location:
  • Phone: 912-704-7977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number058868
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN014660
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: