Individual
DR. LACEY J HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
103 WOODROW WILSON DR, VALDOSTA, GA 31602-2539
(229) 242-8088
Mailing address
103 WOODROW WILSON DR, VALDOSTA, GA 31602-2539
(229) 242-8088
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN015636
GA
Other
Enumeration date
07/16/2018
Last updated
04/23/2024
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