Mark Richard Hanselman, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901014713 Issued in MI

Practice address

1303 Packard St
Suite 202
Ann Arbor, MI 48104-3874

Phone

(734) 769-1130

Fax

(734) 769-2816

NPI assigned

Aug 22, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1295841351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4706 PARKSIDE CT",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059440",
            "telephone_number": "734-913-8121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 PACKARD ST",
            "address_2": "SUITE 202",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481043874",
            "telephone_number": "734-769-1130",
            "fax_number": "734-769-2816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSELMAN",
        "first_name": "MARK",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901014713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Erin Hannan, LMT
• Mark Charles Hannibal, M.D., PH.D.
• Susanna M Hanrath, LMSW
• Andrea G. Hansell, PH.D.
• Susan Hansell, RN, BSN, MBA
• Barbara Marie Hansen, MSW
• Darby Katherine Hansen, CNM
• Jesse Evan Hansen
• Rebekah Bissell Hansen, PSY.D., LP
• Sean Owen Hansen, MD

• General Practice Dentistry in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.