Provider Demographics
NPI:1336697226
Name:TALLAHASSEE PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:TALLAHASSEE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-597-0573
Mailing Address - Street 1:2304 KILLEARN CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3580
Mailing Address - Country:US
Mailing Address - Phone:850-666-5365
Mailing Address - Fax:850-666-5365
Practice Address - Street 1:2304 KILLEARN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3580
Practice Address - Country:US
Practice Address - Phone:850-666-5365
Practice Address - Fax:850-666-5365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty