Provider Demographics
NPI:1528183076
Name:LANZONE HANNIGAN, WANDA JEAN (DMD)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:JEAN
Last Name:LANZONE HANNIGAN
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 1:71 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6001
Mailing Address - Country:US
Mailing Address - Phone:203-255-7771
Mailing Address - Fax:203-255-5753
Practice Address - Street 1:51 BARNSWALLOW DR
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-2554
Practice Address - Country:US
Practice Address - Phone:203-452-1846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT83401223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics