Provider Demographics
NPI:1447425582
Name:DAVID L. HANSON DDS.,PC.
Entity Type:Organization
Organization Name:DAVID L. HANSON DDS.,PC.
Other - Org Name:THREE LAKES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDSPC
Authorized Official - Phone:989-366-8643
Mailing Address - Street 1:1090 W HOUGHTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PRUDENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48651-9613
Mailing Address - Country:US
Mailing Address - Phone:989-366-8643
Mailing Address - Fax:989-366-9525
Practice Address - Street 1:1090 W HOUGHTON LAKE DR
Practice Address - Street 2:
Practice Address - City:PRUDENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48651-9613
Practice Address - Country:US
Practice Address - Phone:989-366-8643
Practice Address - Fax:989-366-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty