MEDICARE: WILLARD HANKINS JR., D.D.S., INC.

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	36552	CA
2	305R00000X	Preferred Provider Organization	36552	CA

General Provider Information

NPI Number	:	1225125446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLARD HANKINS JR., D.D.S., INC.

Provider Business Mailing Address
First Line	:	5509 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3736
Country	:	US
Telephone Number	:	562-421-8206
Fax Number	:	562-497-1885

Provider Business Practice Location Address
First Line	:	5509 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3736
Country	:	US
Telephone Number	:	562-421-8206
Fax Number	:	562-497-1885

Authorized Official
Title or Position	:	CEO
Name	:	DR. WILLARD HANKINS JR.
Credential	:	DDS
Telephone Number	:	562-421-8206

Provider Enumeration Date	:	10/08/2006
Last Update Date	:	01/15/2009

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