Individual
DR. TIMOTHY A HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4702 N PENNGROVE WAY STE 100, MERIDIAN, ID 83646-7449
(208) 938-1825
(208) 938-5763
Mailing address
4702 N PENNGROVE WAY STE 100, MERIDIAN, ID 83646-7449
(208) 938-1825
(208) 938-5763
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3513
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806797300
—
ID
Enumeration date
12/06/2005
Last updated
05/14/2026
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