Provider Demographics
NPI:1679905368
Name:HAN DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:HAN DENTAL GROUP PLLC
Other - Org Name:SOUTH HILL FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DONGWU
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:253-848-2988
Mailing Address - Street 1:11201 88TH AVE E.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3802
Mailing Address - Country:US
Mailing Address - Phone:253-848-2988
Mailing Address - Fax:253-840-9221
Practice Address - Street 1:11201 88TH AVE E
Practice Address - Street 2:SUITE 110
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3802
Practice Address - Country:US
Practice Address - Phone:253-848-2988
Practice Address - Fax:253-840-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty