Provider Demographics
NPI:1700100542
Name:HANSON, KERRI-ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KERRI-ANNE
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-1444
Mailing Address - Country:US
Mailing Address - Phone:850-215-3339
Mailing Address - Fax:888-788-5217
Practice Address - Street 1:707 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2574
Practice Address - Country:US
Practice Address - Phone:850-376-3516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN189041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice