Provider Demographics
NPI:1194796680
Name:HANSELL, JOHN CLARENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLARENCE
Last Name:HANSELL
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 1:8585 HURON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80260-4778
Mailing Address - Country:US
Mailing Address - Phone:303-427-2769
Mailing Address - Fax:303-427-1782
Practice Address - Street 1:8585 HURON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80260-4778
Practice Address - Country:US
Practice Address - Phone:303-427-2769
Practice Address - Fax:303-427-1782
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35751223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics