Provider Demographics
NPI:1528003944
Name:EID, HANI (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:HANI
Middle Name:
Last Name:EID
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 OLYMPIA WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3929
Mailing Address - Country:US
Mailing Address - Phone:360-636-1900
Mailing Address - Fax:
Practice Address - Street 1:1717 OLYMPIA WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3929
Practice Address - Country:US
Practice Address - Phone:360-636-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000096691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5045679Medicaid