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
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
09/24/2017
Last updated
11/04/2020
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