Provider Demographics
NPI:1093094344
Name:HANNON, STEPHANIE ANN THERESA (DDS, MS)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ANN THERESA
Last Name:HANNON
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4040
Mailing Address - Country:US
Mailing Address - Phone:704-865-8521
Mailing Address - Fax:
Practice Address - Street 1:525 S NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4040
Practice Address - Country:US
Practice Address - Phone:704-865-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics