Provider Demographics
NPI:1023843976
Name:HANSEN, BRIANNA KAY WINTER (RDH)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:KAY WINTER
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 OAK ST STE A
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2005
Mailing Address - Country:US
Mailing Address - Phone:503-357-9122
Mailing Address - Fax:
Practice Address - Street 1:1951 OAK ST STE A
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2005
Practice Address - Country:US
Practice Address - Phone:503-357-9122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6578124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD6578OtherOREGON BOARD OF DENTISTRY