Provider Demographics
NPI:1922567692
Name:HANNAHAN ENDODONTIC GROUP
Entity Type:Organization
Organization Name:HANNAHAN ENDODONTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-342-1002
Mailing Address - Street 1:3602B OLD SHELL RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1307
Mailing Address - Country:US
Mailing Address - Phone:251-342-1002
Mailing Address - Fax:251-342-1058
Practice Address - Street 1:3602B OLD SHELL RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1307
Practice Address - Country:US
Practice Address - Phone:251-342-1002
Practice Address - Fax:251-342-1058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANNAHAN ENDODONTIC GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51091426OtherBLUE CROSS BLUE SHIELD OF ALABAMA
855939OtherUNITED CONCORDIA