MEDICARE: DR. STEPHEN JOSEPH HANNON II DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	4351	NC

General Provider Information

NPI Number	:	1700099876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN JOSEPH HANNON II DDS, MS

Provider Business Mailing Address
First Line	:	525 S NEW HOPE RD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-4040
Country	:	US
Telephone Number	:	704-865-8521
Fax Number	:	704-866-0780

Provider Business Practice Location Address
First Line	:	525 S NEW HOPE RD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-4040
Country	:	US
Telephone Number	:	704-865-8521
Fax Number	:	704-866-0780

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

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

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