Provider Demographics
NPI:1154310092
Name:HANSON, KENT WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:WAYNE
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 1:216 E TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:KS
Mailing Address - Zip Code:67554-3618
Mailing Address - Country:US
Mailing Address - Phone:620-257-5021
Mailing Address - Fax:620-257-5393
Practice Address - Street 1:216 E TAYLOR ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-3618
Practice Address - Country:US
Practice Address - Phone:620-257-5021
Practice Address - Fax:620-257-5393
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS49721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5987OtherBLUE CROSS BLUE SHIELD
KS10954OtherEASY DENTAL