Individual
DR. JONATHAN GRANT HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1400 SOUTHWEST BLVD, SUITE C, JEFFERSON CITY, MO 65109-2490
(573) 635-7216
(573) 635-2646
Mailing address
1400 SOUTHWEST BLVD, SUITE C, JEFFERSON CITY, MO 65109-2490
(573) 635-7216
(573) 635-2646
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
011885
MO
Other
Enumeration date
08/22/2006
Last updated
07/08/2007
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