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General NPI Number Information
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NPI Number | 1033054929
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Entity Type | Organization
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Legal Business Name | GREENHORN FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 4130 REDWOOD LN UNIT 130
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City | PUEBLO
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State | CO
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Zip | 81005-3292
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Country | US
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Telephone | 719-564-1102
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Fax |
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Provider Business Mailing Address
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Address Line | 4130 REDWOOD LN UNIT 130
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City | PUEBLO
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State | CO
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Zip | 81005-3292
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT TRENT HANSEN
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Credential |
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Telephone | 316-300-9114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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