Provider Demographics
NPI:1356402499
Name:HANSEN, GREG C (DDS)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:C
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ST ANNES CHURCH ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1495
Mailing Address - Country:US
Mailing Address - Phone:302-378-8600
Mailing Address - Fax:302-378-8602
Practice Address - Street 1:106 ST ANNES CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1495
Practice Address - Country:US
Practice Address - Phone:302-378-8600
Practice Address - Fax:302-378-8602
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10000951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000926008Medicaid