MEDICARE: MARK T. HANSTEIN, D.D.S., INC.

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	4693	OK

General Provider Information

NPI Number	:	1306012158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK T. HANSTEIN, D.D.S., INC.

Provider Business Mailing Address
First Line	:	201 ROBERT S KERR AVE
Second Line	:	SUITE 521
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-4223
Country	:	US
Telephone Number	:	405-235-7288
Fax Number	:	405-235-9581

Provider Business Practice Location Address
First Line	:	201 ROBERT S KERR AVE
Second Line	:	SUITE 521
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-4223
Country	:	US
Telephone Number	:	405-235-7288
Fax Number	:	405-235-9581

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK TANNER HANSTEIN
Credential	:	D.D.S.
Telephone Number	:	405-235-7288

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/01/2008

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