Provider Demographics
NPI:1659587293
Name:HANSON, KIRK M (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:M
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 1:10618 COMBIE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8916
Mailing Address - Country:US
Mailing Address - Phone:530-269-2278
Mailing Address - Fax:530-268-0953
Practice Address - Street 1:10618 COMBIE RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8916
Practice Address - Country:US
Practice Address - Phone:530-269-2278
Practice Address - Fax:530-268-0953
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADJ31468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist