Provider Demographics
NPI:1578642120
Name:HANLON, JANET LENORE
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:LENORE
Last Name:HANLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUNNY
Other - Middle Name:
Other - Last Name:HANLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:2150-2 RED ROCK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86405
Mailing Address - Country:US
Mailing Address - Phone:928-729-5683
Mailing Address - Fax:928-729-8888
Practice Address - Street 1:CORNER OF RT. N12 & N7
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86405
Practice Address - Country:US
Practice Address - Phone:928-729-8885
Practice Address - Fax:928-729-8888
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13005541A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist