MEDICARE: MARY ANN HANLON INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	30019265	OH

General Provider Information

NPI Number	:	1154442168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY ANN HANLON INC

Provider Business Mailing Address
First Line	:	5213 N BEND RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-8025
Country	:	US
Telephone Number	:	513-662-4867
Fax Number	:	513-662-3070

Provider Business Practice Location Address
First Line	:	5213 N BEND RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-8025
Country	:	US
Telephone Number	:	513-662-4867
Fax Number	:	513-662-3070

Authorized Official
Title or Position	:	PERIODONTIST
Name	:	DR. MARY ANN HANLON
Credential	:	D.D.S. M.S.
Telephone Number	:	513-662-4867

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/22/2020

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