Individual
DR. HEIDI J HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
4805 NE GLISAN ST STE 11N, PORTLAND, OR 97213-2933
(503) 215-1676
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
055295
NY
122300000X
Dentist
D11216
OR
125Q00000X
Oral Medicine Dentistry
055295
NY
125Q00000X
Oral Medicine Dentistry
Primary
D11216
OR
Other
Enumeration date
04/08/2009
Last updated
10/23/2023
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