MEDICARE: DR. RYLAN JAMES HANSEN D.D.S.

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	1223G0001X	General Practice Dentistry	9343	NC

General Provider Information

NPI Number	:	1205199106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYLAN JAMES HANSEN D.D.S.

Provider Business Mailing Address
First Line	:	114 OLDHAM PL
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-9004
Country	:	US
Telephone Number	:	919-923-6496
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 W WILLIAMS ST STE 240
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27502-5204
Country	:	US
Telephone Number	:	919-323-8444
Fax Number	:	919-363-6391

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

Provider Enumeration Date	:	06/17/2012
Last Update Date	:	12/19/2018

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