Provider Demographics
NPI:1083628630
Name:HANSON, CRAIG MCLEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MCLEAN
Last Name:HANSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39520 WOODWARD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5054
Mailing Address - Country:US
Mailing Address - Phone:248-645-9797
Mailing Address - Fax:248-645-9004
Practice Address - Street 1:39520 WOODWARD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5054
Practice Address - Country:US
Practice Address - Phone:248-645-9797
Practice Address - Fax:248-645-9004
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist