MEDICARE: DR. MARY ANN HANLON D.D.S., M.S.

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	1223P0300X	Periodontics	30.019265	OH

General Provider Information

NPI Number	:	1245249721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ANN HANLON D.D.S., M.S.

Provider Business Mailing Address
First Line	:	5213 NORTH BEND ROAD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-8025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5213 NORTH BEND ROAD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-8025
Country	:	US
Telephone Number	:	513-662-4867
Fax Number	:	513-662-3070

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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