Provider Demographics
NPI:1871378513
Name:PUNNOOSE, HANNA (DDS)
Entity type:Individual
Prefix:DR
First Name:HANNA
Middle Name:
Last Name:PUNNOOSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 GLENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4018
Mailing Address - Country:US
Mailing Address - Phone:847-274-5219
Mailing Address - Fax:
Practice Address - Street 1:1615 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-1443
Practice Address - Country:US
Practice Address - Phone:224-938-9417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019034609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist