Provider Demographics
NPI:1154947372
Name:PRESTON G. HANSEN, DDS, PLLC
Entity type:Organization
Organization Name:PRESTON G. HANSEN, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-251-7167
Mailing Address - Street 1:7138 S HIGHLAND DR STE 211
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3787
Mailing Address - Country:US
Mailing Address - Phone:801-251-7167
Mailing Address - Fax:801-880-4559
Practice Address - Street 1:7138 S HIGHLAND DR STE 211
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3787
Practice Address - Country:US
Practice Address - Phone:801-251-7167
Practice Address - Fax:801-880-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental