Provider Demographics
NPI:1972545838
Name:HANSTEIN, MARK TANNER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:TANNER
Last Name:HANSTEIN
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 1:201 ROBERT S KERR AVE
Mailing Address - Street 2:SUITE 521
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-4205
Mailing Address - Country:US
Mailing Address - Phone:405-235-7288
Mailing Address - Fax:405-235-9581
Practice Address - Street 1:201 ROBERT S KERR AVE
Practice Address - Street 2:SUITE 521
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-4205
Practice Address - Country:US
Practice Address - Phone:405-235-7288
Practice Address - Fax:405-235-9581
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice