Provider Demographics
NPI:1366026676
Name:ENGAGE ORTHODONTICS-HANSON SC
Entity Type:Organization
Organization Name:ENGAGE ORTHODONTICS-HANSON SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:920-884-2808
Mailing Address - Street 1:1756 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-7121
Mailing Address - Country:US
Mailing Address - Phone:920-884-2808
Mailing Address - Fax:920-884-2966
Practice Address - Street 1:1756 CARDINAL LN
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-7121
Practice Address - Country:US
Practice Address - Phone:920-884-2808
Practice Address - Fax:920-884-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty