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General NPI Number Information
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NPI Number | 1114045937
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Entity Type | Organization
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Legal Business Name | HANSEN FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 05/14/2021
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Provider Practice Location Address
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Address Line | 6615 W ARGENT RD
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City | PASCO
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State | WA
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Zip | 99301-1905
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Country | US
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Telephone | 509-547-9951
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Fax | 509-547-3008
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Provider Business Mailing Address
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Address Line | 6615 W ARGENT RD
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City | PASCO
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State | WA
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Zip | 99301-1905
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Country | US
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Telephone | 509-547-9951
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Fax | 509-547-3008
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Authorized Official
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Title or Position | OWNER
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Name | JAMES R HANSEN
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Credential | DMD
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Telephone | 509-547-9951
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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 | 10263
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License Number State | WA
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