Healthcare Provider Details

I. General information

NPI: 1770937146
Provider Name (Legal Business Name): MICHAEL W. HANSEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7555 E OSBORN RD # 209
SCOTTSDALE AZ
85251-6434
US

IV. Provider business mailing address

7555 E OSBORN RD STE 206
SCOTTSDALE AZ
85251-6442
US

V. Phone/Fax

Practice location:
  • Phone: 480-634-4013
  • Fax:
Mailing address:
  • Phone: 480-634-4013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD010814
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: