MEDICARE: JOHN JOSEPH HANKS DDS

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	D11563	MI

General Provider Information

NPI Number	:	1306964374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JOSEPH HANKS DDS

Provider Business Mailing Address
First Line	:	2730 FIVE MILE ROAD NE
Second Line	:	SUITE 101
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-6518
Country	:	US
Telephone Number	:	616-364-7039
Fax Number	:	616-364-6068

Provider Business Practice Location Address
First Line	:	2730 FIVE MILE ROAD NE
Second Line	:	SUITE 101
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-6518
Country	:	US
Telephone Number	:	616-364-7039
Fax Number	:	616-364-6068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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