Provider Demographics
NPI:1083781751
Name:HANYON, JASON J (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:J
Last Name:HANYON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CATHERINE DR
Mailing Address - Street 2:
Mailing Address - City:EYNON
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1253
Mailing Address - Country:US
Mailing Address - Phone:570-876-4488
Mailing Address - Fax:570-876-1625
Practice Address - Street 1:696 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:EYNON
Practice Address - State:PA
Practice Address - Zip Code:18403-1004
Practice Address - Country:US
Practice Address - Phone:570-876-4488
Practice Address - Fax:570-876-1625
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0360711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice