Provider Demographics
NPI:1740438308
Name:FRED M HANNAN SR, D.D.S., PC
Entity type:Organization
Organization Name:FRED M HANNAN SR, D.D.S., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANNAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-793-3600
Mailing Address - Street 1:4108 WINDSOR SPRING RD
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-5910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4108 WINDSOR SPRING RD
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-5910
Practice Address - Country:US
Practice Address - Phone:706-793-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty