Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D07603 | AZ |
NPI | 1538580113 |
---|---|
Provider Name | Dr. Brian T. Hanstad |
First Address | Phoenix, AZ 85395 |
Second Address | Phoenix, AZ 85395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2013 |
Last Update Date | 26/12/2013 |