Provider Demographics
NPI:1851897391
Name:HANANO, CRYSTAL (DMD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:HANANO
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 1:2112 DEER HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4853
Mailing Address - Country:US
Mailing Address - Phone:323-600-3122
Mailing Address - Fax:
Practice Address - Street 1:10165 FOOTHILL BLVD STE 4
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0341
Practice Address - Country:US
Practice Address - Phone:909-945-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1048221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry