Provider Demographics
NPI:1578758728
Name:HANSON, DONALD M
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:M
Last Name:HANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 E 91ST ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1561
Mailing Address - Country:US
Mailing Address - Phone:317-844-6000
Mailing Address - Fax:317-844-7321
Practice Address - Street 1:70 E 91ST ST
Practice Address - Street 2:SUITE 103
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1561
Practice Address - Country:US
Practice Address - Phone:317-844-6000
Practice Address - Fax:317-844-7321
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist