Provider Demographics
NPI:1881949766
Name:HANLON, JEREMY JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:JOSEPH
Last Name:HANLON
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 1:200 W BEAVER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4820
Mailing Address - Country:US
Mailing Address - Phone:800-446-5680
Mailing Address - Fax:
Practice Address - Street 1:200 W BEAVER AVE STE 100
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4820
Practice Address - Country:US
Practice Address - Phone:800-446-5680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0391151223G0001X, 1223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice