Jonathan Grant Hanson, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

011885 Issued in MO

Practice address

1400 Southwest Blvd
Suite C
Jefferson City, MO 65109-2490

Phone

(573) 635-7216

Fax

(573) 635-2646

NPI assigned

Aug 22, 2006

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jefferson City Oral and Maxillofacial Surgery, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Jefferson City, MO
  • NPI 1760599732
  NPD (past)

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1518073402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 SOUTHWEST BLVD",
            "address_2": "SUITE C",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651092490",
            "telephone_number": "573-635-7216",
            "fax_number": "573-635-2646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 SOUTHWEST BLVD",
            "address_2": "SUITE C",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651092490",
            "telephone_number": "573-635-7216",
            "fax_number": "573-635-2646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSON",
        "first_name": "JONATHAN",
        "middle_name": "GRANT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MO",
            "license": "011885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Autumn A Han, M.D.
• Hand N Hand, LLC
• Hanger Prosthetics & Orthotics East, Inc.
• Alexis Diane Hanks, MOT, OTR/L
• Mason Judd Hansen, DPT
• Robert K Harker, MED
• Harmonic Medical Group of Missouri, P.C.
• Amy Harrell, APN
• Blythe Erin Harris, M.D.
• Clinton Lee Harris, MD

• Oral and Maxillofacial Surgery (Dentist) in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Oral and Maxillofacial Surgery (Dentist) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.