Provider Demographics
NPI:1902272313
Name:HANNAH, GRETTER (DDS, MS)
Entity Type:Individual
Prefix:
First Name:GRETTER
Middle Name:
Last Name:HANNAH
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:GRETTER
Other - Middle Name:
Other - Last Name:HANNAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14440 W 187TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-9522
Mailing Address - Country:US
Mailing Address - Phone:305-479-0955
Mailing Address - Fax:
Practice Address - Street 1:110B N AVON AVE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8475
Practice Address - Country:US
Practice Address - Phone:317-272-7206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012375A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics