Provider Demographics
NPI:1003140930
Name:DR. RICHARD-JAMES M. HANSEN & ASSOCIATES (FORT MILL), P.C.
Entity Type:Organization
Organization Name:DR. RICHARD-JAMES M. HANSEN & ASSOCIATES (FORT MILL), P.C.
Other - Org Name:DENTALWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD-JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-802-1870
Mailing Address - Street 1:PO BOX 860036
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486
Mailing Address - Country:US
Mailing Address - Phone:216-584-1000
Mailing Address - Fax:216-332-7503
Practice Address - Street 1:2435 W HIGHWAY 160
Practice Address - Street 2:SUITE 101
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708
Practice Address - Country:US
Practice Address - Phone:803-802-1870
Practice Address - Fax:216-584-1151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTALONE PARTNES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-24
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4532122300000X, 1223G0001X
1223P0221X, 1223P0300X, 1223P0700X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty