Provider Demographics
NPI:1184840548
Name:JILL E. HANSEN DDS, PS
Entity Type:Organization
Organization Name:JILL E. HANSEN DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-858-9169
Mailing Address - Street 1:6659 KIMBALL DR
Mailing Address - Street 2:SUITE D401
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-5137
Mailing Address - Country:US
Mailing Address - Phone:253-858-9169
Mailing Address - Fax:253-853-6681
Practice Address - Street 1:6659 KIMBALL DR
Practice Address - Street 2:SUITE D401
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5137
Practice Address - Country:US
Practice Address - Phone:253-858-9169
Practice Address - Fax:253-853-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA87401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty