Provider Demographics
NPI:1003880519
Name:SEAN HANSON, DMD, LLC
Entity Type:Organization
Organization Name:SEAN HANSON, DMD, LLC
Other - Org Name:OREGON SMILE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-391-2848
Mailing Address - Street 1:2045 MADRONA AVE SE
Mailing Address - Street 2:SUITE #150
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1149
Mailing Address - Country:US
Mailing Address - Phone:503-391-2848
Mailing Address - Fax:503-391-0402
Practice Address - Street 1:2045 MADRONA AVE SE
Practice Address - Street 2:SUITE #150
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1149
Practice Address - Country:US
Practice Address - Phone:503-391-2848
Practice Address - Fax:503-391-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty