Provider Demographics
NPI:1639555089
Name:HANNA, JOHN (BDS , DDS, MACSD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:HANNA
Suffix:
Gender:M
Credentials:BDS , DDS, MACSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23535 IH 10 W STE 2202
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1673
Mailing Address - Country:US
Mailing Address - Phone:210-687-1444
Mailing Address - Fax:
Practice Address - Street 1:23535 IH 10 W STE 2202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1673
Practice Address - Country:US
Practice Address - Phone:210-687-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-08
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist