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General NPI Number Information
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NPI Number | 1366026676
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Entity Type | Organization
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Legal Business Name | ENGAGE ORTHODONTICS-HANSON SC
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 05/14/2021
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Provider Practice Location Address
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Address Line | 1756 CARDINAL LN
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City | GREEN BAY
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State | WI
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Zip | 54313-7121
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Country | US
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Telephone | 920-884-2808
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Fax | 920-884-2966
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Provider Business Mailing Address
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Address Line | 1756 CARDINAL LN
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City | GREEN BAY
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State | WI
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Zip | 54313-7121
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Country | US
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Telephone | 920-884-2808
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Fax | 920-884-2966
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | MARK H HANSON
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Credential | DDS, MS
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Telephone | 920-884-2808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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