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General NPI Number Information
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NPI Number | 1316268915
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Entity Type | Individual
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Provider Name | JONATHAN MICHAEL HANKS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 7632 S CAMPUS VIEW DR STE 150
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City | WEST JORDAN
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State | UT
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Zip | 84084-5545
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Country | US
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Telephone | 801-282-5439
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Fax |
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Provider Business Mailing Address
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Address Line | W6664 CASBERG COULEE RD
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City | HOLMEN
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State | WI
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Zip | 54636-9038
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Country | US
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Telephone | 361-717-7008
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Fax |
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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 | DEN-10197
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1001174
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 1001174
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | S108
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 9423399
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License Number State | UT
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