Provider Demographics
NPI:1952548174
Name:HANSON, ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:HANSON
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 1:1 GLENRICH DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1610
Mailing Address - Country:US
Mailing Address - Phone:631-242-5959
Mailing Address - Fax:631-257-5417
Practice Address - Street 1:1 GLENRICH DR
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1610
Practice Address - Country:US
Practice Address - Phone:631-242-5959
Practice Address - Fax:631-257-5417
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0494721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice