Hansen, Timothy A
Hansen, Timothy A is an individual health care provider with primary practice located at 4840 N Rosepoint Way Ste A, Boise ID 83713-0954. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Hansen, Timothy A can be contacted via phone (208) 938-1825.Contact Information
Primary practice address
4840 N Rosepoint Way Ste A
Boise ID 83713-0954
Phone: (208) 938-1825
Fax: (208) 938-5763
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | D3513 | Idaho |
Profile Details
| NPI number | 1215911920 |
|---|---|
| LBN Legal business name | Hansen, Timothy A |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 6th, 2005 |
| Last updated | Dec 2nd, 2015 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215911920 | NPPES |
| Idaho | MEDICAID | 806797300 |
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