Healthcare Provider Details

I. General information

NPI: 1568452191
Provider Name (Legal Business Name): DELVIN LEE HANSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 9TH ST W
HARVEY ND
58341-1504
US

IV. Provider business mailing address

117 9TH ST W
HARVEY ND
58341-1504
US

V. Phone/Fax

Practice location:
  • Phone: 701-324-4180
  • Fax:
Mailing address:
  • Phone: 701-324-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1605
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: