Provider Demographics
NPI:1053425546
Name:HANNA, CHARLES B JR (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:B
Last Name:HANNA
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 161899
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-0032
Mailing Address - Country:US
Mailing Address - Phone:864-578-8344
Mailing Address - Fax:864-578-9255
Practice Address - Street 1:1821 OLD FURNACE RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-7427
Practice Address - Country:US
Practice Address - Phone:864-578-8344
Practice Address - Fax:864-578-9255
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice