Provider Demographics
NPI:1174196828
Name:HANNA, SARAH JOSEPHINE (DDS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JOSEPHINE
Last Name:HANNA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 S LAMAR BLVD APT 1510
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0393
Mailing Address - Country:US
Mailing Address - Phone:361-688-4738
Mailing Address - Fax:
Practice Address - Street 1:2100 AUTUMN SLATE DR STE 120
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-6033
Practice Address - Country:US
Practice Address - Phone:361-688-4738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX375471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice