Provider Demographics
NPI:1184144479
Name:HANNA, THOMAS WILLIAM III (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:HANNA
Suffix:III
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 1:111 NOTTAWAY RD
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-8707
Mailing Address - Country:US
Mailing Address - Phone:504-920-9121
Mailing Address - Fax:
Practice Address - Street 1:106 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-4420
Practice Address - Country:US
Practice Address - Phone:318-251-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA67741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice