MEDICARE: HANNA HANANIA DDS,PC

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	0401410445	VA

General Provider Information

NPI Number	:	1699153619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANNA HANANIA DDS,PC

Provider Business Mailing Address
First Line	:	4319 DALE BLVD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2401
Country	:	US
Telephone Number	:	703-897-8554
Fax Number	:	703-897-9615

Provider Business Practice Location Address
First Line	:	4319 DALE BLVD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2401
Country	:	US
Telephone Number	:	703-897-8554
Fax Number	:	703-897-9615

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MRS. CHRISTAL LYNN ALLEN-ROARK
Credential	:
Telephone Number	:	703-897-8554

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	05/11/2015

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