Individual
JODY ERIC HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.D.
Contact information
Practice address
2710 MERIDIAN ST, BELLINGHAM, WA 98225-2411
(360) 676-1499
(360) 738-2281
Mailing address
2710 MERIDIAN ST, BELLINGHAM, WA 98225-2411
(360) 676-1499
(360) 738-2281
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DN00000002
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5020052
—
WA
01
—
DN00000002
WA DENTURIST LICENSE #
WA
Enumeration date
05/23/2007
Last updated
07/09/2007
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