Provider Demographics
NPI:1164983227
Name:MILLER HANSEN, PLLC
Entity Type:Organization
Organization Name:MILLER HANSEN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:ROLAND
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:702-897-1611
Mailing Address - Street 1:1909 N GREEN VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8352
Mailing Address - Country:US
Mailing Address - Phone:702-897-1611
Mailing Address - Fax:702-568-1983
Practice Address - Street 1:1909 N GREEN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8352
Practice Address - Country:US
Practice Address - Phone:702-897-1611
Practice Address - Fax:702-568-1983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLAINE R HANSEN, DMD MS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty