Provider Demographics
NPI:1821572348
Name:HANSEN, CECIL (DDS)
Entity type:Individual
Prefix:
First Name:CECIL
Middle Name:
Last Name:HANSEN
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 1:1204 SAINT TROPEZ DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2931
Mailing Address - Country:US
Mailing Address - Phone:214-718-1429
Mailing Address - Fax:
Practice Address - Street 1:3326 ELSIE FAYE HEGGINS ST # 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-4437
Practice Address - Country:US
Practice Address - Phone:214-718-1429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice