Provider Demographics
NPI:1295828101
Name:HANSEN, SCOTT EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EUGENE
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 1:4820 LINDBERGH DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2093
Mailing Address - Country:US
Mailing Address - Phone:563-449-9743
Mailing Address - Fax:
Practice Address - Street 1:5216 SHERIDAN ST STE 160
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-3972
Practice Address - Country:US
Practice Address - Phone:563-386-7540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0076299Medicaid
IA07524OtherSTATE DENTAL LICENSE