Provider Demographics
NPI:1528139201
Name:HANCOCK, TAD E (DDS)
Entity type:Individual
Prefix:DR
First Name:TAD
Middle Name:E
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 WEST CHUBBUCK ROAD SUITE A
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202
Mailing Address - Country:US
Mailing Address - Phone:208-234-1006
Mailing Address - Fax:208-234-8990
Practice Address - Street 1:485 WEST CHUBBUCK ROAD SUITE A
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202
Practice Address - Country:US
Practice Address - Phone:208-234-1006
Practice Address - Fax:208-234-8990
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID35071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice