Provider Demographics
NPI:1659865822
Name:HANNINEN, KAYLA DAWN (DMD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:DAWN
Last Name:HANNINEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 PONDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2873
Mailing Address - Country:US
Mailing Address - Phone:952-297-5515
Mailing Address - Fax:
Practice Address - Street 1:6140 LAKE LINDEN DR
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-2954
Practice Address - Country:US
Practice Address - Phone:952-474-4123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist