Healthcare Provider Details

I. General information

NPI: 1902747330
Provider Name (Legal Business Name): HANSEN DMD AND HAWKINS DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W MAIN ST
WALLA WALLA WA
99362-2746
US

IV. Provider business mailing address

1363 COLUMBIA PARK TRL STE 201
RICHLAND WA
99352-4770
US

V. Phone/Fax

Practice location:
  • Phone: 509-735-9735
  • Fax:
Mailing address:
  • Phone: 509-735-9735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN HANSEN
Title or Position: OWNER
Credential: DMD
Phone: 509-440-1238