Provider Demographics
NPI:1467671875
Name:HANSEN, DOUGLAS L (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 E STAR CT
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-6701
Mailing Address - Country:US
Mailing Address - Phone:970-249-3330
Mailing Address - Fax:970-249-4171
Practice Address - Street 1:629 E STAR CT
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-6701
Practice Address - Country:US
Practice Address - Phone:970-249-3330
Practice Address - Fax:970-249-4171
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist