Healthcare Provider Details

I. General information

NPI: 1841521572
Provider Name (Legal Business Name): DELVIN HANSEN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 9TH ST W
HARVEY ND
58341-1505
US

IV. Provider business mailing address

1608 GARFIELD ST
HARVEY ND
58341-1808
US

V. Phone/Fax

Practice location:
  • Phone: 701-324-4180
  • Fax:
Mailing address:
  • Phone: 701-341-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1797
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1605
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DELVIN LEE HANSEN
Title or Position: OWNER
Credential: DDS
Phone: 701-324-4180