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General NPI Number Information
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NPI Number | 1114420676
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Entity Type | Individual
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Provider Name | ELISA BATTISTONI HANNAN DMD, MD
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Gender | Female
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 34 DALE RD STE 105
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City | AVON
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State | CT
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Zip | 06001-3659
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Country | US
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Telephone | 860-674-8079
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Fax |
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Provider Business Mailing Address
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Address Line | 34 DALE RD STE 105
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City | AVON
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State | CT
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Zip | 06001-3659
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Country | US
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Telephone | 860-674-8079
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 13976
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 77680
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License Number State | CT
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