Provider Demographics
NPI:1194780007
Name:HANSEN, HENRIK E (DDS)
Entity type:Individual
Prefix:DR
First Name:HENRIK
Middle Name:E
Last Name:HANSEN
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 1:1700 PENNSYLVANIA AVE #C
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3510
Mailing Address - Country:US
Mailing Address - Phone:707-429-2633
Mailing Address - Fax:707-402-6633
Practice Address - Street 1:1700 PENNSYLVANIA AVE #C
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3510
Practice Address - Country:US
Practice Address - Phone:707-429-2633
Practice Address - Fax:707-402-6633
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS275251223G0001X
CA275251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice