Individual
DR. JACOB JOHNSON HANSEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
175 N PENNSYLVANIA AVE, GLENDORA, CA 91741-3316
(626) 963-4173
Mailing address
518 MAGNOLIA ST, DENVER, CO 80220-6014
(801) 918-3866
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
103563
CA
Other
Enumeration date
02/25/2019
Last updated
02/25/2019
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