Provider Demographics
NPI:1629017827
Name:HANSON, BRUCE LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LYNN
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:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850-0626
Mailing Address - Country:US
Mailing Address - Phone:308-324-5551
Mailing Address - Fax:
Practice Address - Street 1:302 E 6TH ST
Practice Address - Street 2:SUITE #3
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-2172
Practice Address - Country:US
Practice Address - Phone:308-324-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE49011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47069568900Medicaid
NE05066OtherBLUE CROSS/ BLUE SHIELD
NEAH9419068OtherDEA REGISTRATION #