Provider Demographics
NPI:1841817962
Name:HANSEN, BRANDT (DMD)
Entity type:Individual
Prefix:DR
First Name:BRANDT
Middle Name:
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 S DOBSON RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6166
Mailing Address - Country:US
Mailing Address - Phone:480-786-4000
Mailing Address - Fax:
Practice Address - Street 1:1120 S DOBSON RD STE 105
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6166
Practice Address - Country:US
Practice Address - Phone:480-786-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist