Provider Demographics
NPI:1699071423
Name:HANSON, THOMAS A (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:HANSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28080 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7005
Mailing Address - Country:US
Mailing Address - Phone:251-621-9404
Mailing Address - Fax:251-621-9653
Practice Address - Street 1:28080 US HIGHWAY 98 STE A
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7012
Practice Address - Country:US
Practice Address - Phone:251-621-9404
Practice Address - Fax:251-621-9653
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL 4301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist