Charles Walden Hanna, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

1631 Issued in SC

Practice address

121 North Pine Street
Batesburg Leesville, SC 29006

Phone

(803) 532-6146

Fax

(803) 532-5807

NPI assigned

Jan 11, 2007

Sex

Male

Sole proprietor

No

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.

• Leishman Dental

  • General Practice Dentistry
  • Batesburg Leesville, SC
  • NPI 1518564046
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in SC

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.

Medicare enrollment (NPD)

Enrolled

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720138852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2409",
            "address_2": "121 NORTH PINE STREET",
            "city": "BATESBURG LEESVILLE",
            "state": "SC",
            "postal_code": "290700409",
            "telephone_number": "803-532-6146",
            "fax_number": "803-532-5807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 NORTH PINE STREET",
            "city": "BATESBURG LEESVILLE",
            "state": "SC",
            "postal_code": "29006",
            "telephone_number": "803-532-6146",
            "fax_number": "803-532-5807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNA",
        "first_name": "CHARLES",
        "middle_name": "WALDEN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "1631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z16313",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Batesburg Leesville, SC
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.