MEDICARE: LOWELL W HANSON 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	1223G0001X	General Practice Dentistry	DEOOOO3944	WA

General Provider Information

NPI Number	:	1962553123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOWELL W HANSON DDS

Provider Business Mailing Address
First Line	:	3100 SQUALICUM PKWY
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1907
Country	:	US
Telephone Number	:	360-676-8200
Fax Number	:	360-671-0979

Provider Business Practice Location Address
First Line	:	3100 SQUALICUM PKWY
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1907
Country	:	US
Telephone Number	:	360-676-8200
Fax Number	:	360-671-0979

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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