MEDICARE: DR. DELVIN LEE HANSEN 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	122300000X	Dentist	1605	ND

General Provider Information

NPI Number	:	1568452191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DELVIN LEE HANSEN DDS

Provider Business Mailing Address
First Line	:	117 9TH ST W
Second Line	:
City	:	HARVEY
State	:	ND
Zip	:	58341-1504
Country	:	US
Telephone Number	:	701-324-4180
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 9TH ST W
Second Line	:
City	:	HARVEY
State	:	ND
Zip	:	58341-1504
Country	:	US
Telephone Number	:	701-324-4180
Fax Number	:

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	02/09/2021

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