Provider Demographics
NPI:1457542284
Name:HANSON, ERIC D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:HANSON
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 1:2820 NW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-6576
Mailing Address - Country:US
Mailing Address - Phone:405-392-4883
Mailing Address - Fax:405-392-4889
Practice Address - Street 1:2820 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6576
Practice Address - Country:US
Practice Address - Phone:405-392-4883
Practice Address - Fax:405-392-4889
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5497384-9922122300000X
OK60931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist