Provider Demographics
NPI:1912449364
Name:R.T.HANSEN,JR., D.M.D., INC.
Entity Type:Organization
Organization Name:R.T.HANSEN,JR., D.M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-870-0310
Mailing Address - Street 1:1321 N HARBOR BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4124
Mailing Address - Country:US
Mailing Address - Phone:714-870-0310
Mailing Address - Fax:714-870-0153
Practice Address - Street 1:1321 N HARBOR BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4124
Practice Address - Country:US
Practice Address - Phone:714-870-0310
Practice Address - Fax:714-870-0153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R.T.HANSEN,JR., D.M.D., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty