Provider Demographics
NPI:1871514356
Name:HANIGAN, SUSAN GILMOUR (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GILMOUR
Last Name:HANIGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 W 6TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-1217
Mailing Address - Country:US
Mailing Address - Phone:213-624-6654
Mailing Address - Fax:213-629-4720
Practice Address - Street 1:523 W 6TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-1217
Practice Address - Country:US
Practice Address - Phone:213-624-6654
Practice Address - Fax:213-629-4720
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0349611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice