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General NPI Number Information
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NPI Number | 1215911920
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Entity Type | Individual
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Provider Name | TIMOTHY A HANSEN DDS
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Gender | Male
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 12/02/2015
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Provider Practice Location Address
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Address Line | 4840 N ROSEPOINT WAY STE A
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City | BOISE
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State | ID
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Zip | 83713-0954
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Country | US
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Telephone | 208-938-1825
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Fax | 208-938-5763
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Provider Business Mailing Address
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Address Line | 4840 N ROSEPOINT WAY STE A
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City | BOISE
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State | ID
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Zip | 83713-0954
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Country | US
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Telephone | 208-938-1825
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Fax | 208-938-5763
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D3513
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License Number State | ID
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