Provider Demographics
NPI:1265579205
Name:HANNAN, DAVID MICHAEL (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:HANNAN
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 1:2006 E MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3539
Mailing Address - Country:US
Mailing Address - Phone:847-255-0410
Mailing Address - Fax:
Practice Address - Street 1:324 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-5161
Practice Address - Country:US
Practice Address - Phone:847-724-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190188941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice