Provider Demographics
NPI:1306069505
Name:HANSON, BASS (DDS)
Entity type:Individual
Prefix:
First Name:BASS
Middle Name:
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 1:7172 HAWTHORN AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-3284
Mailing Address - Country:US
Mailing Address - Phone:213-480-1382
Mailing Address - Fax:
Practice Address - Street 1:10823 HAWTHORNE BLVD STE A
Practice Address - Street 2:
Practice Address - City:LENNOX
Practice Address - State:CA
Practice Address - Zip Code:90304-4322
Practice Address - Country:US
Practice Address - Phone:310-412-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48285122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist