Active NPI
Michael A Hansen, DMD
- Dentist
- Port Washington, WI
National Provider Identifier
1356511059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5750-015
- Practice address
- 428 W Grand Ave
Port Washington, WI 53074-2142 - Phone
- (262) 284-5231
- NPI assigned
- Mar 10, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 5750-015 | WI | Primary |
Addresses
Primary practice location
428 W Grand Ave
Port Washington, WI 53074-2142
Mailing address
428 W Grand Ave
Port Washington, WI 53074-2142
Phone (262) 284-5231
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5750-015 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205107200000",
"number": "1356511059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "428 W GRAND AVE",
"city": "PORT WASHINGTON",
"state": "WI",
"postal_code": "530742142",
"telephone_number": "262-284-5231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "428 W GRAND AVE",
"city": "PORT WASHINGTON",
"state": "WI",
"postal_code": "530742142",
"telephone_number": "262-284-5231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSEN",
"first_name": "MICHAEL",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-03-10",
"last_updated": "2008-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "5750-015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Washington, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.