Individual provider Active NPI

Sharon E Hanne, DMD

  • General Practice Dentistry
  • Edwardsville, IL
National Provider Identifier
1649317702
Registry record updated Oct 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
015867 Issued in MO
Practice address
6655 Edwardsville Crossing Dr Ste D
Edwardsville, IL 62025-2708
Phone
(618) 972-8655
Fax
(618) 692-6975
NPI assigned
Jan 30, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 015867 MO Primary
Dentist 122300000X 019.024344 IL

Addresses

Primary practice location

6655 Edwardsville Crossing Dr Ste D
Edwardsville, IL 62025-2708

Mailing address

6655 Edwardsville Crossing Dr Ste D
Edwardsville, IL 62025-2708
Phone (618) 972-8655

Other identifiers 1

IdentifierTypeStateIssuer
403393918MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230919001291 IL Practitioner - Dentist 0547624926 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019.024344ILMDDentist
015867MOMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Hanne Dental, Inc. Dentist CurrentSince Jul 24, 2022 Accepting new patients

Locations

6655 Edwardsville Crossing Dr
Ste D
Edwardsville, IL 62025
Phone (618) 972-8655

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256169600000",
    "number": "1649317702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6655 EDWARDSVILLE CROSSING DR STE D",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252708",
            "telephone_number": "618-972-8655",
            "fax_number": "618-692-6975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6655 EDWARDSVILLE CROSSING DR STE D",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252708",
            "telephone_number": "618-972-8655",
            "fax_number": "618-692-6975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNE",
        "first_name": "SHARON",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2009-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "015867",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.024344",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "403393918",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edwardsville, IL

Sources for this page

Verify at the official NPI Registry.