Provider Demographics
NPI:1134137185
Name:HANNA, SAMIR K
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:K
Last Name:HANNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-4101
Mailing Address - Country:US
Mailing Address - Phone:904-384-5571
Mailing Address - Fax:904-384-0877
Practice Address - Street 1:2135 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-4101
Practice Address - Country:US
Practice Address - Phone:904-384-5571
Practice Address - Fax:904-384-0877
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL92231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice