Provider Demographics
NPI:1902922099
Name:HANNA, WILLIAM R (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:HANNA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1124 S LAKE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4313
Mailing Address - Country:US
Mailing Address - Phone:817-332-9393
Mailing Address - Fax:817-332-9340
Practice Address - Street 1:1124 S LAKE ST
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4313
Practice Address - Country:US
Practice Address - Phone:817-332-9393
Practice Address - Fax:817-332-9340
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist