Thomas Walter Hansen, DDS
Individual provider Active NPI Dentist · Dawson, MN
NPI 1164540910 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164540910
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 9171 (MN)
- Practice address
- 792 6TH St
Dawson, MN 56232-0456 - Phone
- (320) 769-4756
- Fax
- (320) 769-4756
- NPI assigned
- Mar 27, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160829003145 | MN | Order and Referring Only - Dentist |
2365737384 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9171 | MN | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9171 | MN | Yes |
Addresses
Primary practice location
792 6TH St
Dawson, MN 56232-0456
Mailing address
PO Box 456
792 6TH St
Dawson, MN 56232-0456
Phone (320) 769-4756
Other providers in Dawson, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.