Provider Demographics
NPI:1821115338
Name:BYRONN G HAHN DMD PC
Entity Type:Organization
Organization Name:BYRONN G HAHN DMD PC
Other - Org Name:SOUTHRIDGE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BYRONN
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-777-4700
Mailing Address - Street 1:1000 WIGWAM PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8164
Mailing Address - Country:US
Mailing Address - Phone:702-777-4700
Mailing Address - Fax:702-777-0700
Practice Address - Street 1:1000 WIGWAM PKWY STE 120
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8164
Practice Address - Country:US
Practice Address - Phone:702-777-4700
Practice Address - Fax:702-777-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV51051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty