Provider Demographics
NPI:1295228716
Name:ALMANZAR, HANS (DDS)
Entity Type:Individual
Prefix:
First Name:HANS
Middle Name:
Last Name:ALMANZAR
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 1:139 SW PORT ST LUCIE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5031
Mailing Address - Country:US
Mailing Address - Phone:954-817-3974
Mailing Address - Fax:
Practice Address - Street 1:139 SW PORT ST LUCIE BLVD STE A
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5031
Practice Address - Country:US
Practice Address - Phone:954-817-3974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-09
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN255231223G0001X
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program