Healthcare Provider Details

I. General information

NPI: 1376800391
Provider Name (Legal Business Name): NATHAN HANSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2012
Last Update Date: 08/21/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5168 HONPIE RD
PLACERVILLE CA
95667-8682
US

IV. Provider business mailing address

1860 HOWE AVE STE 440
SACRAMENTO CA
95825-1098
US

V. Phone/Fax

Practice location:
  • Phone: 530-387-4232
  • Fax:
Mailing address:
  • Phone: 916-569-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: