Charles Martin Hanneman, D.D.S.
Individual provider Active NPI General Practice Dentistry · Centerville, IN
NPI 1891805883 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1891805883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 12007996 (IN)
- Practice address
- 100 Mattie Harris Rd
Centerville, IN 47330-1335 - Phone
- (765) 855-3435
- Fax
- (765) 855-2590
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12007996 | IN | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12007996 | IN | Yes |
Addresses
Primary practice location
100 Mattie Harris Rd
Centerville, IN 47330-1335
Mailing address
100 Mattie Harris Rd
Centerville, IN 47330-1335
Phone (765) 855-3435
Other providers in Centerville, IN
- Jayme Brooks
- Lisa Ann Broyles
- Centervilleabington CS
- Aubrey Madison Davis
- Hila Handler
- Kimberly Henry
- Lindsey Marie Humphreys
- Zia Ullah Khan
- Mackenzie Lanman
- Charlotte Darlene McArter
All providers in Centerville, IN · General Practice Dentistry in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.