Provider Demographics
NPI:1265456081
Name:HANSSMANN, DENNETT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNETT
Middle Name:JOHN
Last Name:HANSSMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 4TH STREET, #A5
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4152
Mailing Address - Country:US
Mailing Address - Phone:916-452-3030
Mailing Address - Fax:
Practice Address - Street 1:509 4TH STREET, #A5
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4152
Practice Address - Country:US
Practice Address - Phone:916-452-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-331442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7386517Medicaid
CAC-33144OtherMEDICAL LICENSE NUMBER
CA7386517Medicaid
CAA35181Medicare UPIN