Provider Demographics
NPI:1033148234
Name:HANNA, JR., GEORGE E (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:E
Last Name:HANNA, JR.
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 1:612 PASTEUR DR
Mailing Address - Street 2:STE.101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1149
Mailing Address - Country:US
Mailing Address - Phone:336-292-1990
Mailing Address - Fax:336-292-4738
Practice Address - Street 1:612 PASTEUR DR
Practice Address - Street 2:STE.101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1149
Practice Address - Country:US
Practice Address - Phone:336-292-1990
Practice Address - Fax:336-292-4738
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993545Medicaid