Individual
DR. PAUL LLOYD HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
625 W BRIDGE ST, BLACKFOOT, ID 83221-2018
(208) 785-2685
(208) 785-0998
Mailing address
PO BOX 458, BLACKFOOT, ID 83221-0458
(208) 785-2685
(208) 785-0998
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3613
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806356900
—
ID
Enumeration date
04/08/2010
Last updated
04/08/2010
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