Provider Demographics
NPI:1235393638
Name:HANSON, CHRISTOPHER MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MARK
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 1:1061 E MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5724
Mailing Address - Country:US
Mailing Address - Phone:530-477-6172
Mailing Address - Fax:
Practice Address - Street 1:1061 E MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5724
Practice Address - Country:US
Practice Address - Phone:530-477-6172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist