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General NPI Number Information
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NPI Number | 1780251827
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Entity Type | Individual
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Provider Name | CONNER J HANSEN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 1905 PLAZA DR
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City | EAGAN
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State | MN
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Zip | 55122-2883
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Country | US
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Telephone | 651-686-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 1970 WALNUT ST
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City | LAUDERDALE
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State | MN
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Zip | 55113-5136
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Country | US
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Telephone | 414-731-1992
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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 | D14576
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License Number State | MN
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