Provider Demographics
NPI:1912099367
Name:HANKLA, JOHN WEBB (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WEBB
Last Name:HANKLA
Suffix:
Gender:M
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:PO BOX 476
Mailing Address - Street 2:1000 EAST LEXINGTON AVE GREENLEAF SHOPPING CTR STE 35
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-0476
Mailing Address - Country:US
Mailing Address - Phone:859-236-2243
Mailing Address - Fax:859-238-4186
Practice Address - Street 1:1000 EAST LEXINGTON AVE
Practice Address - Street 2:GREENLEAF SHOPPING CENTER STE 35
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40423-0476
Practice Address - Country:US
Practice Address - Phone:859-236-2243
Practice Address - Fax:859-238-4186
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY5008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60050085Medicaid