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General NPI Number Information
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NPI Number | 1972027878
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Entity Type | Organization
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Legal Business Name | HANNE DENTAL, INC.
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6655 EDWARDSVILLE CROSSING DR STE D
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-2708
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Country | US
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Telephone | 618-972-8655
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Fax | 618-656-9701
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Provider Business Mailing Address
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Address Line | 6655 EDWARDSVILLE CROSSING DR STE D
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-2708
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Country | US
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Telephone | 618-972-8655
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Fax | 618-656-9701
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Authorized Official
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Title or Position | OWNER
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Name | SHARON HANNE
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Credential | DMD
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Telephone | 618-972-8655
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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 | 015867
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 019.024344
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.024344
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License Number State | IL
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