Provider Demographics
NPI:1598758518
Name:HANNIGAN, JOSEPH DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DAVID
Last Name:HANNIGAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 BROWNSBORO RD
Mailing Address - Street 2:STE 6
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-3900
Mailing Address - Country:US
Mailing Address - Phone:502-429-5005
Mailing Address - Fax:502-426-0733
Practice Address - Street 1:10000 BROWNSBORO RD
Practice Address - Street 2:STE 6
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-3900
Practice Address - Country:US
Practice Address - Phone:502-429-5005
Practice Address - Fax:502-426-0733
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY78431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice