Provider Demographics
NPI:1134542376
Name:LINDSEY A HANS, DMD LTD
Entity type:Organization
Organization Name:LINDSEY A HANS, DMD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-356-9855
Mailing Address - Street 1:2918 CROSSING CT STE A
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-6100
Mailing Address - Country:US
Mailing Address - Phone:217-356-9855
Mailing Address - Fax:217-356-9750
Practice Address - Street 1:2918 CROSSING CT STE A
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-6100
Practice Address - Country:US
Practice Address - Phone:217-356-9855
Practice Address - Fax:217-356-9750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINDSEY HANS DMD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-23
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IL0193027486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty