MEDICARE: THOMAS EDWARD HANSON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	25898	CA

General Provider Information

NPI Number	:	1255778130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS EDWARD HANSON D.D.S.

Provider Business Mailing Address
First Line	:	3840 WOODRUFF AVE
Second Line	:	SUITE 202
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2143
Country	:	US
Telephone Number	:	562-421-9411
Fax Number	:	562-421-9433

Provider Business Practice Location Address
First Line	:	3840 WOODRUFF AVE
Second Line	:	SUITE 202
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2143
Country	:	US
Telephone Number	:	562-421-9411
Fax Number	:	562-421-9433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	05/31/2013

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