MEDICARE: DR. JEFFREY A. HANKINSON DMD

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	22DI01292400	NJ

General Provider Information

NPI Number	:	1629072988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY A. HANKINSON DMD

Provider Business Mailing Address
First Line	:	20 KNOB HILL DR
Second Line	:
City	:	SUMMIT
State	:	NJ
Zip	:	07901-3025
Country	:	US
Telephone Number	:	908-277-2925
Fax Number	:	973-376-5749

Provider Business Practice Location Address
First Line	:	58 CHATHAM RD
Second Line	:
City	:	SHORT HILLS
State	:	NJ
Zip	:	07078-2321
Country	:	US
Telephone Number	:	973-376-5268
Fax Number	:	973-376-5749

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/08/2007

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