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General NPI Number Information
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NPI Number | 1528183076
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Entity Type | Individual
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Provider Name | WANDA JEAN LANZONE HANNIGAN D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 51 BARNSWALLOW DR
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City | TRUMBULL
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State | CT
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Zip | 06611-2554
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Country | US
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Telephone | 203-452-1846
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Fax |
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Provider Business Mailing Address
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Address Line | 71 BEACH RD
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City | FAIRFIELD
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State | CT
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Zip | 06824-6001
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Country | US
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Telephone | 203-255-7771
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Fax | 203-255-5753
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 8340
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License Number State | CT
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