Healthcare Provider Details

I. General information

NPI: 1538506746
Provider Name (Legal Business Name): JOHN PATRICK HANLON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7826 LOUIS PASTEUR DR STE 103
SAN ANTONIO TX
78229-3410
US

IV. Provider business mailing address

11815 VANCE JACKSON RD APT 1201
SAN ANTONIO TX
78230-1456
US

V. Phone/Fax

Practice location:
  • Phone: 480-280-6903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number28789
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: