Provider Demographics
NPI:1750460945
Name:HANSEN, BENNETT LEE (DDS)
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:LEE
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 1:10600 BELLAIRE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5231
Mailing Address - Country:US
Mailing Address - Phone:281-495-9080
Mailing Address - Fax:
Practice Address - Street 1:10600 BELLAIRE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5231
Practice Address - Country:US
Practice Address - Phone:281-495-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice