Provider Demographics
NPI:1013506690
Name:HANI, DANA (DDS)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:HANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W WESTERN AVE APT 2113
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-2242
Mailing Address - Country:US
Mailing Address - Phone:317-605-2536
Mailing Address - Fax:
Practice Address - Street 1:112 IRONWORKS AVE STE B1
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2058
Practice Address - Country:US
Practice Address - Phone:574-285-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013537A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist