Provider Demographics
NPI:1689783623
Name:HANSEN, NEIL ARIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:ARIEL
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 1:12330 NE 8TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3187
Mailing Address - Country:US
Mailing Address - Phone:425-455-0442
Mailing Address - Fax:425-451-3669
Practice Address - Street 1:12330 NE 8TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3187
Practice Address - Country:US
Practice Address - Phone:425-455-0442
Practice Address - Fax:425-451-3669
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5576122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5008537Medicaid