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Organization
SPA DENTAL, PC
Active
Organization
SPA DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES T HANSEN D,M.D. (OWNER/PRESIDENT)
(518) 885-1791
Entity
Organization
Contact information
Practice address
68 MILTON AVENUE, BALLSTON SPA, NY 12020
(518) 885-1791
(518) 885-1147
Mailing address
68 MILTON AVENUE, BALLSTON SPA, NY 12020
(518) 885-1791
(518) 885-1147
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
046659
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03275514
—
NY
Enumeration date
09/05/2012
Last updated
09/05/2012
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