MEDICARE: DR HANENBAUM&PINA,P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4029	MD

General Provider Information

NPI Number	:	1154428852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR HANENBAUM&PINA,P.A.

Provider Business Mailing Address
First Line	:	10401 NEW HAMPSHIRE AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-1120
Country	:	US
Telephone Number	:	301-439-1030
Fax Number	:	301-439-4253

Provider Business Practice Location Address
First Line	:	10401 NEW HAMPSHIRE AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-1120
Country	:	US
Telephone Number	:	301-439-1030
Fax Number	:	301-439-4253

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. ALLEN NMN HANENBAUM
Credential	:	DDS
Telephone Number	:	301-439-1030

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	08/05/2008

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