Healthcare Provider Details

I. General information

NPI: 1245249721
Provider Name (Legal Business Name): MARY ANN HANLON D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5213 NORTH BEND ROAD
CINCINNATI OH
45247-8025
US

IV. Provider business mailing address

5213 NORTH BEND ROAD
CINCINNATI OH
45247-8025
US

V. Phone/Fax

Practice location:
  • Phone: 513-662-4867
  • Fax: 513-662-3070
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number30.019265
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: