Provider Demographics
NPI:1053690446
Name:ANDREA HANNAHAN, DDS, PLLC
Entity type:Organization
Organization Name:ANDREA HANNAHAN, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:LORI
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-487-9997
Mailing Address - Street 1:1012C CROSSINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2787
Mailing Address - Country:US
Mailing Address - Phone:931-487-9997
Mailing Address - Fax:931-487-9998
Practice Address - Street 1:1012C CROSSINGS BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2787
Practice Address - Country:US
Practice Address - Phone:931-487-9997
Practice Address - Fax:931-487-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS85811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506459Medicaid