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General NPI Number Information
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NPI Number | 1548583479
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Entity Type | Individual
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Provider Name | STAN HANES D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2010
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Last Update Date | 03/06/2010
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Provider Practice Location Address
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Address Line | USC SCHOOL OF DENTISTRY 925 W 34TH ST ORAL AND MAXILLOFACIAL SURGERY DEPT
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City | LOS ANGELES
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State | CA
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Zip | 90089-0001
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Country | US
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Telephone | 213-740-8112
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10054
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City | ZEPHYR COVE
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State | NV
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Zip | 89448-2054
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Country | US
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Telephone | 775-762-5094
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 17475
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License Number State | CA
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