Provider Demographics
NPI:1558430868
Name:HANSON, PAMELA RAE (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:RAE
Last Name:HANSON
Suffix:
Gender:F
Credentials:DDS MS
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Other - Credentials:
Mailing Address - Street 1:20855 WATERTOWN RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186
Mailing Address - Country:US
Mailing Address - Phone:262-798-1421
Mailing Address - Fax:262-798-1494
Practice Address - Street 1:20855 WATERTOWN RD
Practice Address - Street 2:SUITE 240
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186
Practice Address - Country:US
Practice Address - Phone:262-798-1421
Practice Address - Fax:262-798-1494
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI4074 0151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics