Provider Demographics
NPI:1073621645
Name:ROBERT N. HANSON D.D.S., P.C.
Entity Type:Organization
Organization Name:ROBERT N. HANSON D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:816-373-5606
Mailing Address - Street 1:17500 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE #1
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1823
Mailing Address - Country:US
Mailing Address - Phone:816-373-5606
Mailing Address - Fax:816-373-7042
Practice Address - Street 1:17500 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE #1
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1823
Practice Address - Country:US
Practice Address - Phone:816-373-5606
Practice Address - Fax:816-373-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO120371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty