Provider Demographics
NPI:1083011837
Name:HANNIG, ANNETTE S (RDHAP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:S
Last Name:HANNIG
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-2220
Mailing Address - Country:US
Mailing Address - Phone:805-602-7718
Mailing Address - Fax:
Practice Address - Street 1:1741 8TH ST
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-2220
Practice Address - Country:US
Practice Address - Phone:805-602-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist