Provider Demographics
NPI:1043405194
Name:HAN, DAVID S (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:HAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 JASONWAY AVE
Mailing Address - Street 2:SUITE 2-A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4333
Mailing Address - Country:US
Mailing Address - Phone:614-457-8888
Mailing Address - Fax:
Practice Address - Street 1:770 JASONWAY AVE
Practice Address - Street 2:SUITE 2-A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4333
Practice Address - Country:US
Practice Address - Phone:614-457-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19698122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist