Provider Demographics
NPI:1619189107
Name:HANSON, J. KRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:KRIS
Last Name:HANSON
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 1:1955 S 1300 E
Mailing Address - Street 2:STE 2
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3638
Mailing Address - Country:US
Mailing Address - Phone:801-487-5502
Mailing Address - Fax:801-487-7120
Practice Address - Street 1:1955 S 1300 E
Practice Address - Street 2:STE 2
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-3638
Practice Address - Country:US
Practice Address - Phone:801-487-5502
Practice Address - Fax:801-487-7120
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT199318101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice