Provider Demographics
NPI:1699022269
Name:MARCUS A HANNAH DDS LLC
Entity Type:Organization
Organization Name:MARCUS A HANNAH DDS LLC
Other - Org Name:KAILUA DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HANNAH
Authorized Official - Suffix:
Authorized Official - Credentials:DD,S
Authorized Official - Phone:808-254-5454
Mailing Address - Street 1:970 N KALAHEO AVE
Mailing Address - Street 2:SUITE A305
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1866
Mailing Address - Country:US
Mailing Address - Phone:808-254-5454
Mailing Address - Fax:808-254-5427
Practice Address - Street 1:970 N KALAHEO AVE
Practice Address - Street 2:SUITE A305
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1866
Practice Address - Country:US
Practice Address - Phone:808-254-5454
Practice Address - Fax:808-254-5427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI20781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty