MEDICARE: DR. PAUL DOUGLAS HANNA 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	122300000X	Dentist	7103429-9922	UT

General Provider Information

NPI Number	:	1568485472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL DOUGLAS HANNA DDS

Provider Business Mailing Address
First Line	:	7086 HIGHLAND DR STE 100
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3768
Country	:	US
Telephone Number	:	801-942-5520
Fax Number	:

Provider Business Practice Location Address
First Line	:	7086 HIGHLAND DR STE 100
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3768
Country	:	US
Telephone Number	:	801-942-5520
Fax Number	:

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	02/10/2010

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