Provider Demographics
NPI:1578666400
Name:CHURCHILL, HANS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:HANS
Middle Name:L
Last Name:CHURCHILL
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 1:1785 W HIGHWAY 89A
Mailing Address - Street 2:STE 3G
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5567
Mailing Address - Country:US
Mailing Address - Phone:928-282-9414
Mailing Address - Fax:
Practice Address - Street 1:1785 W HIGHWAY 89A
Practice Address - Street 2:STE 3G
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5577
Practice Address - Country:US
Practice Address - Phone:928-282-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice