Roger M. Hanawalt, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

28704 Issued in CA

Practice address

2450 D St
La Verne, CA 91750-4416

Phone

(909) 593-4581

Fax

(909) 593-4129

NPI assigned

Nov 10, 2005

Last updated

Nov 13, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Hanawalt Dental Corporation

  • General Practice Dentistry
  • La Verne, CA
  • NPI 1962890632
  NPD (past) Authorized official
• Hanawalt Wes Dental Corporation

  • General Practice Dentistry
  • La Verne, CA
  • NPI 1427625581
  NPD (past)

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194912000000",
    "number": "1861473357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 D ST",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917504416",
            "telephone_number": "909-593-4581",
            "fax_number": "909-593-4129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 D ST",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917504416",
            "telephone_number": "909-593-4581",
            "fax_number": "909-593-4129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANAWALT",
        "first_name": "ROGER",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2007-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "28704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan L Haly, LMFT
• Ryan Patrick Hamann, PA
• Hanawalt Dental Corporation
• Hanawalt Wes Dental Corporation
• Peri Lynn Hanawalt, D.M.D.
• Mary Justina Hanna, OTR/L
• Susan Harman, FNP
• Nailah N Harris
• Sean Harris
• Harry Confer DPM

• General Practice Dentistry in La Verne, CA
• Providers in La Verne, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.