Provider Demographics
NPI:1619316551
Name:HANSON, WESLEY LOUIS JR (DDS)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:LOUIS
Last Name:HANSON
Suffix:JR
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 1:1040 NE HOSTMARK ST
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7337
Mailing Address - Country:US
Mailing Address - Phone:360-779-4556
Mailing Address - Fax:360-779-1212
Practice Address - Street 1:1040 NE HOSTMARK ST
Practice Address - Street 2:SUITE 100A
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7337
Practice Address - Country:US
Practice Address - Phone:360-779-4556
Practice Address - Fax:360-779-1212
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE64041223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics