Provider Demographics
NPI:1326120320
Name:HANNS, STEPHEN J (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:HANNS
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 1:888 FAIRWAY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2814
Mailing Address - Country:US
Mailing Address - Phone:503-224-7815
Mailing Address - Fax:503-222-0029
Practice Address - Street 1:833 SW 11TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2117
Practice Address - Country:US
Practice Address - Phone:503-224-7815
Practice Address - Fax:503-222-0029
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD62331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice