Healthcare Provider Details

I. General information

NPI: 1568487312
Provider Name (Legal Business Name): CLAYTON M HANSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 E 20 S STE B
AMERICAN FORK UT
84003-3834
US

IV. Provider business mailing address

356 E 20 S STE B
AMERICAN FORK UT
84003-3834
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-2809
  • Fax: 801-763-5439
Mailing address:
  • Phone: 801-756-2809
  • Fax: 801-763-5439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number355197
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: