Provider Demographics
NPI:1508981762
Name:HANNA, EVA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:ANN
Last Name:HANNA
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 1:737 W GOLF RD # 11
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2414
Mailing Address - Country:US
Mailing Address - Phone:847-228-2000
Mailing Address - Fax:847-228-1010
Practice Address - Street 1:737 W GOLF RD # 11
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2414
Practice Address - Country:US
Practice Address - Phone:847-228-2000
Practice Address - Fax:847-228-1010
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1005497Medicaid