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General NPI Number Information
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NPI Number | 1528635612
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Entity Type | Individual
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Provider Name | HANNAH GRACE TAW DMD
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Gender | Female
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 1231 GEORGE TOWNE DR STE D
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City | PEWAUKEE
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State | WI
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Zip | 53072-2756
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Country | US
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Telephone | 262-691-9832
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Fax | 262-691-9871
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Provider Business Mailing Address
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Address Line | 10105 JOHN ASHLEY CT
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City | LOUISVILLE
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State | KY
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Zip | 40299-5867
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Country | US
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Telephone | 901-355-9445
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 6001033-15
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10584
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6001033-15
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License Number State | WI
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