Provider Demographics
NPI:1629459532
Name:HANLON, DANIAL JOEL
Entity Type:Individual
Prefix:
First Name:DANIAL
Middle Name:JOEL
Last Name:HANLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:NE
Mailing Address - Zip Code:69033-1408
Mailing Address - Country:US
Mailing Address - Phone:308-882-5123
Mailing Address - Fax:308-882-5141
Practice Address - Street 1:510 W 12TH ST
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:NE
Practice Address - Zip Code:69033-3200
Practice Address - Country:US
Practice Address - Phone:308-882-5123
Practice Address - Fax:308-882-5141
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72261223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice