Provider Demographics
NPI:1902026503
Name:HANSEN, LISA E (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:E
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1987 ROYAL AVE
Mailing Address - Street 2:SUITE # 4
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4655
Mailing Address - Country:US
Mailing Address - Phone:805-527-3306
Mailing Address - Fax:805-578-6529
Practice Address - Street 1:1987 ROYAL AVE
Practice Address - Street 2:SUITE # 4
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4655
Practice Address - Country:US
Practice Address - Phone:805-527-3306
Practice Address - Fax:805-578-6529
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice