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General NPI Number Information
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NPI Number | 1649393885
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Entity Type | Individual
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Provider Name | PATRICIA MAUREEN HANLON D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 1149 OLD COUNTRY RD SUITE B-1
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City | RIVERHEAD
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State | NY
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Zip | 11901-2057
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Country | US
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Telephone | 631-369-0300
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Fax | 631-369-0301
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Provider Business Mailing Address
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Address Line | 1149 OLD COUNTRY RD SUITE B-1
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City | RIVERHEAD
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State | NY
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Zip | 11901-2057
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Country | US
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Telephone | 631-369-0300
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Fax | 631-369-0301
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 39273
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License Number State | NY
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