Healthcare Provider Details

I. General information

NPI: 1083723662
Provider Name (Legal Business Name): TIMOTHY A. HANIGAN DDS,MS,PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 E KANSAS AVE
GARDEN CITY KS
67846-6233
US

IV. Provider business mailing address

1620 E KANSAS AVE
GARDEN CITY KS
67846-6233
US

V. Phone/Fax

Practice location:
  • Phone: 620-271-0299
  • Fax:
Mailing address:
  • Phone: 620-271-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7055
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: