Healthcare Provider Details

I. General information

NPI: 1962207860
Provider Name (Legal Business Name): INGRID ANN HANSEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 17TH AVE
GRAFTON WI
53024-2004
US

IV. Provider business mailing address

5905 N LYDELL AVE UNIT 235
GLENDALE WI
53217-4587
US

V. Phone/Fax

Practice location:
  • Phone: 262-618-0717
  • Fax:
Mailing address:
  • Phone: 920-393-0923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6001798
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: