Provider Demographics
NPI:1154550945
Name:HANSON, THOMAS M (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
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 1:1100 HIGHWAY 25 N STE 1
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2024
Mailing Address - Country:US
Mailing Address - Phone:763-682-9796
Mailing Address - Fax:763-682-4821
Practice Address - Street 1:1100 HIGHWAY 25 N STE 1
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2024
Practice Address - Country:US
Practice Address - Phone:763-682-9796
Practice Address - Fax:763-682-4821
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice