Provider Demographics
NPI:1285842419
Name:HANNEMAN, DONALD JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JOHN
Last Name:HANNEMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 WESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-2641
Mailing Address - Country:US
Mailing Address - Phone:608-754-0474
Mailing Address - Fax:608-754-1253
Practice Address - Street 1:2021 WESLEY AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-2641
Practice Address - Country:US
Practice Address - Phone:608-754-0474
Practice Address - Fax:608-754-1253
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50004210151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice