MEDICARE: DR. JOHN CLARENCE HANSELL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	3575	CO

General Provider Information

NPI Number	:	1194796680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CLARENCE HANSELL DDS

Provider Business Mailing Address
First Line	:	8585 HURON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80260-4778
Country	:	US
Telephone Number	:	303-427-2769
Fax Number	:	303-427-1782

Provider Business Practice Location Address
First Line	:	8585 HURON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80260-4778
Country	:	US
Telephone Number	:	303-427-2769
Fax Number	:	303-427-1782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	07/08/2007

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