Provider Demographics
NPI:1760868632
Name:HANSON, KYLE (DDS)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
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 1:8420 S 71ST PLZ
Mailing Address - Street 2:107
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-2138
Mailing Address - Country:US
Mailing Address - Phone:402-934-7550
Mailing Address - Fax:402-934-7582
Practice Address - Street 1:8420 S 71ST PLZ
Practice Address - Street 2:107
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68133-2138
Practice Address - Country:US
Practice Address - Phone:402-934-7550
Practice Address - Fax:402-934-7582
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist