Individual
TIMOTHY HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2592 S 5600 W STE 102, WEST VALLEY CITY, UT 84120-1274
(801) 613-2904
Mailing address
695 WINDSOR CT, ALPINE, UT 84004-1934
(385) 219-0372
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12885953-9922
UT
Other
Enumeration date
06/07/2022
Last updated
06/07/2022
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