MEDICARE: DR. TIMOTHY JAMES HANNON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	046318	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114066727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY JAMES HANNON DDS

Provider Business Mailing Address
First Line	:	51 BRYNSTONE CT
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14228-3703
Country	:	US
Telephone Number	:	716-691-7053
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 DELAWARE RD
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14217-2742
Country	:	US
Telephone Number	:	716-874-9981
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/09/2007

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