Provider Demographics
NPI:1548091663
Name:HANNEY, AMELIA (DDS)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:HANNEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 PHEASANT HILL CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-5823
Mailing Address - Country:US
Mailing Address - Phone:408-826-7356
Mailing Address - Fax:
Practice Address - Street 1:801 RIVER DR
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5404
Practice Address - Country:US
Practice Address - Phone:707-964-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1105291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice