Provider Demographics
NPI:1437122041
Name:HANA, SUZAN M (DDS)
Entity type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:M
Last Name:HANA
Suffix:
Gender:F
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:E8 BRIER HILL CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3336
Mailing Address - Country:US
Mailing Address - Phone:732-390-9093
Mailing Address - Fax:732-390-9383
Practice Address - Street 1:E8 BRIER HILL CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3336
Practice Address - Country:US
Practice Address - Phone:732-390-9093
Practice Address - Fax:732-390-9383
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019495001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8065608Medicaid
NJ22-3678500OtherTAX ID