Provider Demographics
NPI:1063570505
Name:HANSON, REBECCA ANN (DDS, MS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:HANSON
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 W SAINT GERMAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4121
Mailing Address - Country:US
Mailing Address - Phone:320-255-1111
Mailing Address - Fax:320-255-1602
Practice Address - Street 1:1411 W SAINT GERMAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4121
Practice Address - Country:US
Practice Address - Phone:320-255-1111
Practice Address - Fax:320-255-1602
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics