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General NPI Number Information
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NPI Number | 1922682830
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Entity Type | Individual
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Provider Name | CHAD KEVIN HANNIBAL DDS
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Gender | Male
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Dates
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Enumeration Date | 05/06/2021
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 1013 SPRING LN
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City | SANFORD
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State | NC
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Zip | 27330-3459
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Country | US
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Telephone | 919-718-5561
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 SPRING LN
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City | SANFORD
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State | NC
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Zip | 27330-3459
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Country | US
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Telephone | 919-718-5561
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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 | 13221
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License Number State | NC
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