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General NPI Number Information
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NPI Number | 1033959580
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Entity Type | Individual
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Provider Name | MARIAM HANNA
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Gender | Female
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 4401 E 10TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46201-2744
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Country | US
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Telephone | 317-659-9045
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Fax |
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Provider Business Mailing Address
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Address Line | 7060 WOODGATE CIR
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City | FISHERS
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State | IN
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Zip | 46038-1772
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Country | US
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Telephone | 317-384-0659
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12014418A
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License Number State | IN
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