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General NPI Number Information
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NPI Number | 1851897391
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Entity Type | Individual
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Provider Name | CRYSTAL HANANO DMD
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Gender | Female
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 10165 FOOTHILL BLVD STE 4
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0341
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Country | US
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Telephone | 909-945-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 2112 DEER HAVEN DR
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City | CHINO HILLS
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State | CA
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Zip | 91709-4853
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Country | US
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Telephone | 323-600-3122
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 104822
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License Number State | CA
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