Provider Demographics
NPI:1528552296
Name:HANSER, KATHERINE SUE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:SUE
Last Name:HANSER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:IL
Mailing Address - Zip Code:62001-2124
Mailing Address - Country:US
Mailing Address - Phone:618-972-6769
Mailing Address - Fax:
Practice Address - Street 1:2800 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4742
Practice Address - Country:US
Practice Address - Phone:618-972-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031672122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist