Provider Demographics
NPI:1639367949
Name:HANSEN, LAWRENCE DEAN (DDS)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:DEAN
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:PO BOX 270535
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96127-0009
Mailing Address - Country:US
Mailing Address - Phone:530-310-4700
Mailing Address - Fax:
Practice Address - Street 1:501 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-2326
Practice Address - Country:US
Practice Address - Phone:916-323-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist