MEDICARE: HANNONPIAZZADDSPLLC

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	:	1841501103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANNONPIAZZADDSPLLC

Provider Business Mailing Address
First Line	:	39 DELAWARE RD
Second Line	:
City	:	KENMORE
State	:	NY
Zip	:	14217-2742
Country	:	US
Telephone Number	:	716-874-9981
Fax Number	:	716-873-5839

Provider Business Practice Location Address
First Line	:	39 DELAWARE RD
Second Line	:
City	:	KENMORE
State	:	NY
Zip	:	14217-2742
Country	:	US
Telephone Number	:	716-874-9981
Fax Number	:	716-873-5839

Authorized Official
Title or Position	:	DENTIST/PARTNER
Name	:	DR. TIMOTHY JAMES HANNON
Credential	:	DDS
Telephone Number	:	716-874-9981

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	07/01/2010

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