Provider Demographics
NPI:1598760530
Name:HANNA, LORRAINE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:D
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 1:4017 W MAIN ST
Mailing Address - Street 2:STE 300
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-3731
Mailing Address - Country:US
Mailing Address - Phone:269-349-3203
Mailing Address - Fax:269-349-5721
Practice Address - Street 1:4017 W MAIN ST
Practice Address - Street 2:STE 300
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-3731
Practice Address - Country:US
Practice Address - Phone:269-349-3203
Practice Address - Fax:269-349-5721
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI159181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice