Provider Demographics
NPI:1548980766
Name:HOUGHTALING, HANNAH GRACE (DDS)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:GRACE
Last Name:HOUGHTALING
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 1:809 DEKLEVA DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-1724
Mailing Address - Country:US
Mailing Address - Phone:269-317-8852
Mailing Address - Fax:
Practice Address - Street 1:13700 N US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8980
Practice Address - Country:US
Practice Address - Phone:352-259-0822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist