Provider Demographics
NPI:1225226343
Name:HANSEN, STEPHEN W (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 REGENT ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8662
Mailing Address - Country:US
Mailing Address - Phone:509-440-1238
Mailing Address - Fax:
Practice Address - Street 1:10505 W CLEARWATER AVE
Practice Address - Street 2:BLDG A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8613
Practice Address - Country:US
Practice Address - Phone:509-735-9735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2010-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9072122300000X
WADE601446731223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist