Healthcare Provider Details

I. General information

NPI: 1922896489
Provider Name (Legal Business Name): HAILEY REBECCA HANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1376 HIGHWAY 17 N
NORTH MYRTLE BEACH SC
29582-2551
US

IV. Provider business mailing address

308 LA CANTERA CT
LAS VEGAS NV
89144-1532
US

V. Phone/Fax

Practice location:
  • Phone: 843-353-3405
  • Fax:
Mailing address:
  • Phone: 702-428-4598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8445
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11065
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: