Provider Demographics
NPI:1851594162
Name:HANSON, SEAN MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MICHAEL
Last Name:HANSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3887 ROGUE AVE S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-9518
Mailing Address - Country:US
Mailing Address - Phone:503-391-2848
Mailing Address - Fax:
Practice Address - Street 1:2045 MADRONA AVE SE
Practice Address - Street 2:SUITE #150
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1149
Practice Address - Country:US
Practice Address - Phone:503-391-2848
Practice Address - Fax:503-391-0402
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist