Provider Demographics
NPI:1174287668
Name:AMANDA HANNA DDS INC
Entity type:Organization
Organization Name:AMANDA HANNA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:ARCHIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-534-2633
Mailing Address - Street 1:3710 PACIFIC COAST HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5914
Mailing Address - Country:US
Mailing Address - Phone:310-534-2633
Mailing Address - Fax:562-658-2922
Practice Address - Street 1:3710 PACIFIC COAST HWY STE 101
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5914
Practice Address - Country:US
Practice Address - Phone:310-534-2633
Practice Address - Fax:562-658-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA64093OtherDENTIST