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General NPI Number Information
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NPI Number | 1659094621
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Entity Type | Individual
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Provider Name | AMANDA CHURCH HANSEN DMD
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Gender | Female
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 385 STARR RD STE 202
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City | LANDENBERG
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State | PA
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Zip | 19350-9223
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Country | US
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Telephone | 610-268-2040
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Fax | 610-268-2061
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Provider Business Mailing Address
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Address Line | 112 ARUNDEL LN
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City | ELKTON
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State | MD
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Zip | 21921-7338
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Country | US
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Telephone | 302-561-4666
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS043898
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License Number State | PA
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