Provider Demographics
NPI:1528300118
Name:HANSEN, CARRIE (DDS)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7057 W 130TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7841
Mailing Address - Country:US
Mailing Address - Phone:440-887-0550
Mailing Address - Fax:440-887-0553
Practice Address - Street 1:7057 W 130TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7841
Practice Address - Country:US
Practice Address - Phone:440-887-0550
Practice Address - Fax:440-887-0553
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.019363122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist