Provider Demographics
NPI:1114420676
Name:HANNAN, ELISA BATTISTONI (DMD, MD)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:BATTISTONI
Last Name:HANNAN
Suffix:
Gender:F
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 DALE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3659
Mailing Address - Country:US
Mailing Address - Phone:860-674-8079
Mailing Address - Fax:
Practice Address - Street 1:34 DALE RD STE 105
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3659
Practice Address - Country:US
Practice Address - Phone:860-674-8079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT139761223S0112X
CT77680204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery