Provider Demographics
NPI:1225215387
Name:HANSON, HEATHER CAROL (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:CAROL
Last Name:HANSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 SUNRISE AVE.
Mailing Address - Street 2:STE. 120
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661
Mailing Address - Country:US
Mailing Address - Phone:916-797-0868
Mailing Address - Fax:916-787-0818
Practice Address - Street 1:750 SUNRISE AVE.
Practice Address - Street 2:SUITE 120
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-797-0868
Practice Address - Fax:916-797-0818
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice