Provider Demographics
NPI:1952401150
Name:HAHN, JACK A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:A
Last Name:HAHN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 BARRY LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-1743
Mailing Address - Country:US
Mailing Address - Phone:513-281-2333
Mailing Address - Fax:513-281-4902
Practice Address - Street 1:910 BARRY LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-1743
Practice Address - Country:US
Practice Address - Phone:513-281-2333
Practice Address - Fax:513-281-4902
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4334122300000X
OH124721223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223D0001XDental ProvidersDentistDental Public Health