Provider Demographics
NPI:1285955070
Name:HANSON, BENJAMIN LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LAWRENCE
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 1:16866 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8586
Mailing Address - Country:US
Mailing Address - Phone:248-765-4272
Mailing Address - Fax:
Practice Address - Street 1:19249 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1189
Practice Address - Country:US
Practice Address - Phone:734-615-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010201831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice