Individual
DR. JORDAN JOSEPH HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
169 N GATEWAY DRIVE, SUITE 200, PROVIDENCE, UT 84332
(435) 241-7707
(435) 514-6983
Mailing address
169 N GATEWAY DRIVE, SUITE 200, PROVIDENCE, UT 84332
(435) 241-7707
(435) 514-6983
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8362186-9921
UT
1223E0200X
Endodontics
Primary
8362186-9922
UT
Other
Enumeration date
08/06/2012
Last updated
10/24/2018
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