Provider Demographics
NPI:1699187252
Name:HANSEN, JASON R (DDS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
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 1:7515 QUAKER AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-5308
Mailing Address - Country:US
Mailing Address - Phone:806-797-4455
Mailing Address - Fax:806-797-2460
Practice Address - Street 1:7515 QUAKER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-5308
Practice Address - Country:US
Practice Address - Phone:806-797-4455
Practice Address - Fax:806-797-2460
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX298681223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics