Basic Information
| Provider Information | |||||||||
| NPI: | 1134282007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANCHIN | ||||||||
| FirstName: | JOHANNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3189 | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132203189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154546000 | ||||||||
| FaxNumber: | 3154548650 | ||||||||
| Practice Location | |||||||||
| Address1: | 3515 HUDSON DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | STOW | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442242906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309287674 | ||||||||
| FaxNumber: | 3309281884 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 30-021877 | OH | Y | Dental Providers | Dentist |
No ID Information.