Provider Demographics
NPI:1598008153
Name:HANSEN, MATTHEW CHRISTIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CHRISTIAN
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 1:7934 SW 80TH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-9534
Mailing Address - Country:US
Mailing Address - Phone:801-920-4023
Mailing Address - Fax:
Practice Address - Street 1:7934 SW 80TH DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-9534
Practice Address - Country:US
Practice Address - Phone:801-920-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDTP6791223X0008X
NY0595851223X0008X
CO002034321223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100065100Medicaid