MEDICARE: GREG A HANSON DDS PROF LLC

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	122300000X	Dentist	M514	SD

General Provider Information

NPI Number	:	1578725842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREG A HANSON DDS PROF LLC

Provider Business Mailing Address
First Line	:	801 MOUNT RUSHMORE RD
Second Line	:	SUITE 201
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3614
Country	:	US
Telephone Number	:	605-341-1895
Fax Number	:	605-348-7177

Provider Business Practice Location Address
First Line	:	801 MOUNT RUSHMORE RD
Second Line	:	SUITE 201
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3614
Country	:	US
Telephone Number	:	605-341-1895
Fax Number	:	605-348-7177

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREG A. HANSON
Credential	:	DDS
Telephone Number	:	605-341-1895

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	06/27/2008

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