Provider Demographics
NPI:1104018688
Name:HANNA, WADIA MEMARI (DMD, MS)
Entity Type:Individual
Prefix:
First Name:WADIA
Middle Name:MEMARI
Last Name:HANNA
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 102ND ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1152
Mailing Address - Country:US
Mailing Address - Phone:518-465-4771
Mailing Address - Fax:518-242-4773
Practice Address - Street 1:6 102ND ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1152
Practice Address - Country:US
Practice Address - Phone:518-465-4771
Practice Address - Fax:518-242-4773
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0535831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice