Provider Demographics
NPI:1275891731
Name:HANSEN, JEFFREY VAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:VAL
Last Name:HANSEN
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 1:1747 HERITAGE LN STE B203
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-8532
Mailing Address - Country:US
Mailing Address - Phone:801-525-1725
Mailing Address - Fax:801-525-0988
Practice Address - Street 1:1747 HERITAGE LN STE B203
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-8532
Practice Address - Country:US
Practice Address - Phone:801-525-1725
Practice Address - Fax:801-525-0988
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT370824-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice