Provider Demographics
NPI:1851303895
Name:DHANE, JOHN M (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:DHANE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1806 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-1330
Mailing Address - Country:US
Mailing Address - Phone:253-912-9383
Mailing Address - Fax:253-912-1480
Practice Address - Street 1:1100 STATION DR STE 281
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-9777
Practice Address - Country:US
Practice Address - Phone:253-912-9383
Practice Address - Fax:253-912-1480
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA75491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics