Provider Demographics
NPI:1225146962
Name:HANSON, ROBERT NORMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NORMAN
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 1:17500 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
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO120371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice