Provider Demographics
NPI:1174798573
Name:SAMIA SHALABY HANNA, DMD, PC
Entity type:Organization
Organization Name:SAMIA SHALABY HANNA, DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMIA
Authorized Official - Middle Name:SHALABY
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:580-353-7244
Mailing Address - Street 1:1320 NW HOMESTEAD DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5243
Mailing Address - Country:US
Mailing Address - Phone:580-353-7244
Mailing Address - Fax:580-353-1244
Practice Address - Street 1:1320 NW HOMESTEAD DR
Practice Address - Street 2:SUITE I
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5243
Practice Address - Country:US
Practice Address - Phone:580-353-7244
Practice Address - Fax:580-353-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty