Provider Demographics
NPI:1306012158
Name:MARK T. HANSTEIN, D.D.S., INC.
Entity Type:Organization
Organization Name:MARK T. HANSTEIN, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:TANNER
Authorized Official - Last Name:HANSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-235-7288
Mailing Address - Street 1:201 ROBERT S KERR AVE
Mailing Address - Street 2:SUITE 521
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-4223
Mailing Address - Country:US
Mailing Address - Phone:405-235-7288
Mailing Address - Fax:405-235-9581
Practice Address - Street 1:201 ROBERT S KERR AVE
Practice Address - Street 2:SUITE 521
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-4223
Practice Address - Country:US
Practice Address - Phone:405-235-7288
Practice Address - Fax:405-235-9581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty