Provider Demographics
NPI:1326240680
Name:GEORGE E. HANNA, JR DDS
Entity Type:Organization
Organization Name:GEORGE E. HANNA, JR DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-292-1990
Mailing Address - Street 1:612 PASTEUR DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403
Mailing Address - Country:US
Mailing Address - Phone:336-292-1990
Mailing Address - Fax:336-292-4738
Practice Address - Street 1:612 PASTEUR DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1149
Practice Address - Country:US
Practice Address - Phone:336-292-1990
Practice Address - Fax:336-292-4738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC465623OtherUNITED CONCORDIA
NC8993545Medicaid
NC8993545Medicaid