Healthcare Provider Details

I. General information

NPI: 1659094621
Provider Name (Legal Business Name): AMANDA CHURCH HANSEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 STARR RD STE 202
LANDENBERG PA
19350-9223
US

IV. Provider business mailing address

112 ARUNDEL LN
ELKTON MD
21921-7338
US

V. Phone/Fax

Practice location:
  • Phone: 610-268-2040
  • Fax: 610-268-2061
Mailing address:
  • Phone: 302-561-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS043898
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: