Eric D Hanson, DDS
Individual provider Active NPI General Practice Dentistry · Newcastle, OK
NPI 1457542284 · NPPES record last updated Feb 24, 2010
Key facts
- NPI
- 1457542284
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 6093 (OK)
- Practice address
- 2820 NW 32ND St
Newcastle, OK 73065-6576 - Phone
- (405) 392-4883
- Fax
- (405) 392-4889
- NPI assigned
- Aug 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- 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 |
|---|---|---|---|---|
| I20200813002612 | UT | Practitioner - Dentist |
2668779554 |
Reassigns benefits to 1 organization Practice locations: St George, UT |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6093 | OK | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Intermountain Dentures PLLC | General Practice | Current |
Accepting new patients |
Locations
1091 N Bluff St
Ste 812
St George, UT 84770
Phone (435) 688-2772
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5497384-9922 | UT | |
| General Practice Dentistry | 1223G0001X | 6093 | OK | Yes |
Addresses
Primary practice location
2820 NW 32ND St
Newcastle, OK 73065-6576
Mailing address
2820 NW 32ND St
Newcastle, OK 73065-6576
Phone (405) 392-4883
Other providers in Newcastle, OK
- Aiden Green
- Paige Green
- Philip Wayne Grider
- Jennifer Joy Griffin
- Ashley Nicole Gutierrez
- Healthcare Stat of Newcastle LLC
- Judy L Hensley
- Jordan Hites
- Candace J Hladik
- Kameron Kimberly Ann Homier
All providers in Newcastle, OK · General Practice Dentistry in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2010. 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.