MEDICARE: DR. JOHN TIMOTHY HANSFORD JR. D.M.D.

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	1223P0221X	Pediatric Dentistry	056107	NY
2	1223D0004X	Dental Anesthesiology	056107	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	:	1386931095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN TIMOTHY HANSFORD JR. D.M.D.

Provider Business Mailing Address
First Line	:	102 NORMAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-2934
Country	:	US
Telephone Number	:	929-324-1140
Fax Number	:

Provider Business Practice Location Address
First Line	:	2171 JERICHO TPKE
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-2937
Country	:	US
Telephone Number	:	631-486-6364
Fax Number	:

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

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	05/17/2016

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Directions to “ DR. JOHN TIMOTHY HANSFORD JR. D.M.D.” Practice Location

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