Provider Demographics
NPI:1437326303
Name:HANYON, STEPHANIE POTTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:POTTER
Last Name:HANYON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 NORTHERN BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9302
Mailing Address - Country:US
Mailing Address - Phone:570-587-5541
Mailing Address - Fax:
Practice Address - Street 1:239 NORTHERN BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9302
Practice Address - Country:US
Practice Address - Phone:570-587-5541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0368971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry