MEDICARE: DR. JOSHUA MICHAEL HANENKRATH DMD, MPH

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	D012304	AZ
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D012304	AZ

General Provider Information

NPI Number	:	1366251555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA MICHAEL HANENKRATH DMD, MPH

Provider Business Mailing Address
First Line	:	4510 E BANNER GATEWAY DR APT 3076
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4760
Country	:	US
Telephone Number	:	419-343-7515
Fax Number	:

Provider Business Practice Location Address
First Line	:	4510 E BANNER GATEWAY DR APT 3076
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4760
Country	:	US
Telephone Number	:	419-343-7515
Fax Number	:

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

Provider Enumeration Date	:	01/02/2025
Last Update Date	:	04/24/2026

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