Provider Demographics
NPI:1235226234
Name:HANSEN, GINGER L (DDS)
Entity Type:Individual
Prefix:DR
First Name:GINGER
Middle Name:L
Last Name:HANSEN
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 1:1235 W VISTA WAY STE F
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6234
Mailing Address - Country:US
Mailing Address - Phone:760-940-0366
Mailing Address - Fax:760-940-2029
Practice Address - Street 1:1235 W VISTA WAY STE F
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6234
Practice Address - Country:US
Practice Address - Phone:760-940-0366
Practice Address - Fax:760-940-2029
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279991223G0001X
AZ27961223G0001X
CO55491223G0001X
ORD60281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice