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General NPI Number Information
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NPI Number | 1477649101
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Entity Type | Individual
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Provider Name | ROBERT PATRICK HANNON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4080 W BROADWAY AVE
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City | ROBBINSDALE
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State | MN
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Zip | 55422-5604
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Country | US
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Telephone | 763-535-3511
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Fax | 952-545-1811
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Provider Business Mailing Address
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Address Line | 9212 HAMPSHIRE AVE N
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City | BROOKLYN PARK
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State | MN
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Zip | 55445-3245
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Country | US
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Telephone | 763-424-3482
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8891
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License Number State | MN
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