Provider Demographics
NPI:1407994593
Name:HANAN, LEWIS (DMD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:
Last Name:HANAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 S TUTTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3112
Mailing Address - Country:US
Mailing Address - Phone:941-366-6161
Mailing Address - Fax:941-366-6162
Practice Address - Street 1:1830 S TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3112
Practice Address - Country:US
Practice Address - Phone:941-366-6161
Practice Address - Fax:941-366-6162
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 0035531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics