Provider Demographics
NPI:1396839874
Name:HANSEN, ALICIA MARIE BERGER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MARIE BERGER
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:605-334-5530
Practice Address - Street 1:5201 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5040
Practice Address - Country:US
Practice Address - Phone:605-339-2200
Practice Address - Fax:605-334-5530
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND122601223G0001X
SDD09331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice