MEDICARE: SUNDANCE DERMATOLOGY, LLC

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1275404022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNDANCE DERMATOLOGY, LLC

Provider Business Mailing Address
First Line	:	768 S 1600 W STE B
Second Line	:
City	:	MAPLETON
State	:	UT
Zip	:	84664-4563
Country	:	US
Telephone Number	:	801-477-6843
Fax Number	:	801-515-0509

Provider Business Practice Location Address
First Line	:	768 S 1600 W STE B
Second Line	:
City	:	MAPLETON
State	:	UT
Zip	:	84664-4563
Country	:	US
Telephone Number	:	801-477-6843
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	DR. ERIC MORGAN HANSON
Credential	:	MD
Telephone Number	:	801-477-6843

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	01/06/2026

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