Provider Demographics
NPI:1275629115
Name:HANZON, JEFFREY DARREL (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DARREL
Last Name:HANZON
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 1:12238 GRASSLAND CT
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-3166
Mailing Address - Country:US
Mailing Address - Phone:801-253-4547
Mailing Address - Fax:801-302-0814
Practice Address - Street 1:2332 W 12600 S
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7161
Practice Address - Country:US
Practice Address - Phone:801-253-4547
Practice Address - Fax:801-302-0814
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT343991-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTBH8851099OtherDEA