# AUSTIN CREEK DENTAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710299433
- **Authorized official:** DR. TIMOTHY A HANSEN DDS (PRESIDENT)
- **Authorized official phone:** (208) 938-1825

## Contact information

- **Practice address:** 4702 N PENNGROVE WAY STE 100, MERIDIAN, ID 83646-7449
- **Practice address phone:** (208) 938-1825
- **Mailing address:** 4702 N PENNGROVE WAY STE 100, MERIDIAN, ID 83646-7449
- **Mailing address phone:** (208) 938-1825
- **Mailing address fax:** (208) 938-5763

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D-3513 | ID | Yes |

## Other

- **Enumeration date:** 07/10/2010
- **Last updated:** 06/04/2026