Provider Demographics
NPI:1427551696
Name:HANAMOVA, ENEJAN (DDS)
Entity Type:Individual
Prefix:
First Name:ENEJAN
Middle Name:
Last Name:HANAMOVA
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 1:204 COUNTRY MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-6212
Mailing Address - Country:US
Mailing Address - Phone:925-640-7682
Mailing Address - Fax:
Practice Address - Street 1:6698 AMADOR PLAZA RD STE A
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2943
Practice Address - Country:US
Practice Address - Phone:925-828-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1016431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty