Provider Demographics
NPI:1487860755
Name:HANCOCK, JOHN THOMAS (DDS,)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:HANCOCK
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 1:1590 NW 10TH AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1313
Mailing Address - Country:US
Mailing Address - Phone:561-391-4744
Mailing Address - Fax:561-391-4678
Practice Address - Street 1:1590 NW 10TH AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1313
Practice Address - Country:US
Practice Address - Phone:561-391-4744
Practice Address - Fax:561-391-4678
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL43181223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics