Healthcare Provider Details

I. General information

NPI: 1588415384
Provider Name (Legal Business Name): DR. AMBER HANSON - DANSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 45TH ST
HIGHLAND IN
46322-2602
US

IV. Provider business mailing address

6507 S KIMBARK AVE APT 1S
CHICAGO IL
60637-4458
US

V. Phone/Fax

Practice location:
  • Phone: 219-934-7896
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number018.002283
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: