Provider Demographics
NPI:1396920435
Name:DOUGLAS HANSEN DDS INC.
Entity type:Organization
Organization Name:DOUGLAS HANSEN DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-266-1433
Mailing Address - Street 1:2507 CHADWICK RD.
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:56013
Mailing Address - Country:US
Mailing Address - Phone:319-266-1433
Mailing Address - Fax:319-266-3749
Practice Address - Street 1:2507 CHADWICK RD.
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:56013
Practice Address - Country:US
Practice Address - Phone:319-266-1433
Practice Address - Fax:319-266-3749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty