Healthcare Provider Details

I. General information

NPI: 1679966808
Provider Name (Legal Business Name): ARSENE HANANA D.D.S, O.M.F.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 N SHEPHERD DR STE B
HOUSTON TX
77018-6411
US

IV. Provider business mailing address

3800 N SHEPHERD DR STE B
HOUSTON TX
77018-6411
US

V. Phone/Fax

Practice location:
  • Phone: 713-510-9475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10680
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDR60555141
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number39451
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: