Provider Demographics
NPI:1992713846
Name:HANSER, RHONDA BETH (DMD)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:BETH
Last Name:HANSER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:BETH
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:334 BARGRAVES BLVD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294
Mailing Address - Country:US
Mailing Address - Phone:618-667-2004
Mailing Address - Fax:618-667-2526
Practice Address - Street 1:334 BARGRAVES BLVD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294
Practice Address - Country:US
Practice Address - Phone:618-667-2004
Practice Address - Fax:618-667-2526
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022264122300000X
IL019.022264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1992713846OtherBLUE CROSS BLUE SHIELD OF ILLINOIS