Provider Demographics
NPI:1992004808
Name:HANOMAN, PAYAL G (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAYAL
Middle Name:G
Last Name:HANOMAN
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 1:5713 WHISPER PINE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-1329
Mailing Address - Country:US
Mailing Address - Phone:561-909-5776
Mailing Address - Fax:
Practice Address - Street 1:5713 WHISPER PINE DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-1329
Practice Address - Country:US
Practice Address - Phone:561-909-5776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN192721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice