Basic Information
Provider Information | |||||||||
NPI: | 1326675588 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HACKNEY | ||||||||
FirstName: | ANNA | ||||||||
MiddleName: | ZITO | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ZITO | ||||||||
OtherFirstName: | ANNA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 301 RANDOLPH ST | ||||||||
Address2: |   | ||||||||
City: | DENTON | ||||||||
State: | MD | ||||||||
PostalCode: | 216291243 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4104794306 | ||||||||
FaxNumber: | 4104791714 | ||||||||
Practice Location | |||||||||
Address1: | 503 MUIR ST STE A | ||||||||
Address2: |   | ||||||||
City: | CAMBRIDGE | ||||||||
State: | MD | ||||||||
PostalCode: | 216131848 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4102289381 | ||||||||
FaxNumber: | 4102289384 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/26/2020 | ||||||||
LastUpdateDate: | 03/26/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/26/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 7179 | MD | Y |   | Dental Providers | Dental Hygienist |   |
No ID Information.