Individual
DR. DOUGLAS CLARK HANNAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1520 COUNTRY CLUB RD, FAIRMONT, WV 26554
(304) 363-9160
(304) 363-3693
Mailing address
1520 COUNTRY CLUB RD, FAIRMONT, WV 26554
(304) 363-9160
(304) 363-3693
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3162
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0134011000
—
WV
Enumeration date
10/23/2006
Last updated
07/08/2007
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