Healthcare Provider Details

I. General information

NPI: 1548951346
Provider Name (Legal Business Name): CRYSTAL SMITH HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 S HICKORY ST
LOXLEY AL
36551-4648
US

IV. Provider business mailing address

2122 S HICKORY ST
LOXLEY AL
36551-4648
US

V. Phone/Fax

Practice location:
  • Phone: 251-964-2671
  • Fax:
Mailing address:
  • Phone: 251-964-2671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD.007203-C1
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: