Provider Demographics
NPI:1508522335
Name:HASENAUER, C. BRUCE (DDS)
Entity Type:Individual
Prefix:
First Name:C. BRUCE
Middle Name:
Last Name:HASENAUER
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 1:6402 S TROY CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6439
Mailing Address - Country:US
Mailing Address - Phone:303-471-0346
Mailing Address - Fax:
Practice Address - Street 1:6402 S TROY CIR STE 300
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-6439
Practice Address - Country:US
Practice Address - Phone:303-471-0346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00008948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist