Provider Demographics
NPI:1700969839
Name:HANSEN, JO E (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:JO
Middle Name:E
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1923
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-7923
Mailing Address - Country:US
Mailing Address - Phone:816-246-4671
Mailing Address - Fax:
Practice Address - Street 1:611 SW 3RD ST
Practice Address - Street 2:SUITE #A
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2212
Practice Address - Country:US
Practice Address - Phone:816-246-4671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0146371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics