Provider Demographics
NPI:1922642263
Name:HANNA AND ANTWAN DENTAL INC
Entity Type:Organization
Organization Name:HANNA AND ANTWAN DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDH/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDERIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-599-5900
Mailing Address - Street 1:3773 WILLOW GLEN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3773 WILLOW GLEN DR STE 100
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4601
Practice Address - Country:US
Practice Address - Phone:619-499-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental