Active NPI
Kyle S Hansen, DMD
- General Practice Dentistry
- Mansfield, TX
National Provider Identifier
1033648100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- NA
- Practice address
- 2771 E Broad St Ste 221
Mansfield, TX 76063-9157 - Phone
- (972) 975-2606
- NPI assigned
- Jun 12, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | NA | TX | Primary |
Addresses
Primary practice location
2771 E Broad St Ste 221
Mansfield, TX 76063-9157
Mailing address
3116 Buena Vista Dr
Plano, TX 75025-3626
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 23, 2021 through Mar 23, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1497225600000",
"number": "1033648100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3116 BUENA VISTA DR",
"city": "PLANO",
"state": "TX",
"postal_code": "750253626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2771 E BROAD ST STE 221",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760639157",
"telephone_number": "972-975-2606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSEN",
"first_name": "KYLE",
"middle_name": "S",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-12",
"last_updated": "2017-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "NA",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.