Healthcare Provider Details

I. General information

NPI: 1225775976
Provider Name (Legal Business Name): ISAAC HANSET, DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2022
Last Update Date: 05/15/2022
Certification Date: 05/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SE 223RD AVE STE 260
GRESHAM OR
97030-2580
US

IV. Provider business mailing address

7745 CHERRY RIVER DR
LAS VEGAS NV
89145-4918
US

V. Phone/Fax

Practice location:
  • Phone: 503-484-7013
  • Fax:
Mailing address:
  • Phone: 503-484-7013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ISAAC LEON HANSET
Title or Position: DOCTOR
Credential: DMD
Phone: 503-484-7013