Organization
MACK AND HANSEN ORTHODONTICS, PLLC
Active
Organization
MACK AND HANSEN ORTHODONTICS, PLLC
Active
Other names
Mack and Hansen Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
SPENCER MCKENZIE MACK DDS, MSD (OWNER/ORTHODONTIST)
(903) 212-7737
Entity
Organization
Contact information
Practice address
1405 JUDSON RD, LONGVIEW, TX 75601-3918
(903) 212-7737
(903) 212-7745
Mailing address
1405 JUDSON RD, LONGVIEW, TX 75601-3918
(903) 212-7737
(903) 212-7745
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
30007
TX
Other
Enumeration date
09/24/2017
Last updated
11/04/2020
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