Provider Demographics
NPI:1992105951
Name:HANSEN, CHAD RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:RICHARD
Last Name:HANSEN
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 1:6655 W SAHARA AVE
Mailing Address - Street 2:A-106
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0842
Mailing Address - Country:US
Mailing Address - Phone:702-876-5800
Mailing Address - Fax:702-876-5927
Practice Address - Street 1:6655 W SAHARA AVE
Practice Address - Street 2:A-106
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0842
Practice Address - Country:US
Practice Address - Phone:702-876-5800
Practice Address - Fax:702-876-5927
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1000987-15122300000X
NVS7-911223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist