Provider Demographics
NPI:1477396489
Name:HANCOCK COMPREHENSIVE DENTISTRY
Entity type:Organization
Organization Name:HANCOCK COMPREHENSIVE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENNON
Authorized Official - Middle Name:LEWAYNE
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:928-551-1464
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936-0930
Mailing Address - Country:US
Mailing Address - Phone:928-337-2522
Mailing Address - Fax:928-337-4881
Practice Address - Street 1:100 N 13TH W
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936-4584
Practice Address - Country:US
Practice Address - Phone:928-337-2522
Practice Address - Fax:928-337-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty