Provider Demographics
NPI:1104497908
Name:HANSON, JOSHUA CHRISTIAN (DDS)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:CHRISTIAN
Last Name:HANSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 38TH ST S STE 106
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7535
Mailing Address - Country:US
Mailing Address - Phone:701-532-2500
Mailing Address - Fax:
Practice Address - Street 1:309 SHEYENNE ST
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-1732
Practice Address - Country:US
Practice Address - Phone:701-282-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist