Provider Demographics
NPI:1821752981
Name:KIDD, HANNAH MACKENZIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:MACKENZIE
Last Name:KIDD
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 1:2DENBN/NDC CAMP LEJEUNE, PSC BOX 20130
Mailing Address - Street 2:315 MCHUGH BLVD
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542
Mailing Address - Country:US
Mailing Address - Phone:910-451-1658
Mailing Address - Fax:
Practice Address - Street 1:2D DENBN/NDC, PSC 20130
Practice Address - Street 2:315 MCHUGH BLVD
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0130
Practice Address - Country:US
Practice Address - Phone:910-451-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN262001223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice