Provider Demographics
NPI:1245805720
Name:R.A HANNA, DDS INC.
Entity Type:Organization
Organization Name:R.A HANNA, DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-965-2340
Mailing Address - Street 1:708 VIAND ST
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-1237
Mailing Address - Country:US
Mailing Address - Phone:304-675-5600
Mailing Address - Fax:304-675-6484
Practice Address - Street 1:708 VIAND ST
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1237
Practice Address - Country:US
Practice Address - Phone:304-675-5600
Practice Address - Fax:304-675-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1962578690Medicaid
OH1962578690Medicaid