Provider Demographics
NPI:1457055618
Name:HANSEN, BRENNAN GARTH (DDS)
Entity type:Individual
Prefix:
First Name:BRENNAN
Middle Name:GARTH
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 1:1691 ASHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-1259
Mailing Address - Country:US
Mailing Address - Phone:307-315-7301
Mailing Address - Fax:
Practice Address - Street 1:4616 MONTEVALLO RD
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-3104
Practice Address - Country:US
Practice Address - Phone:205-202-9540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007223-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist