Provider Demographics
NPI:1982688578
Name:HANNULA, DAVID RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RICHARD
Last Name:HANNULA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4146 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-4013
Mailing Address - Country:US
Mailing Address - Phone:253-759-5622
Mailing Address - Fax:253-761-8441
Practice Address - Street 1:4146 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-4013
Practice Address - Country:US
Practice Address - Phone:253-759-5622
Practice Address - Fax:253-761-8441
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5002902OtherDSHS
WA0017297OtherL & I