Healthcare Provider Details

I. General information

NPI: 1669086252
Provider Name (Legal Business Name): CHANCY HANQUIST DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 N ST
AURORA NE
68818-1621
US

IV. Provider business mailing address

1830 E CONDON AVE
AURORA NE
68818-3135
US

V. Phone/Fax

Practice location:
  • Phone: 402-694-2044
  • Fax: 402-694-6244
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7637
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: