Provider Demographics
NPI:1528446606
Name:HANSEN, MARLEE G (DDS)
Entity type:Individual
Prefix:DR
First Name:MARLEE
Middle Name:G
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 A AVE NE STE LL1
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5064
Mailing Address - Country:US
Mailing Address - Phone:319-369-7730
Mailing Address - Fax:
Practice Address - Street 1:855 A AVE NE STE LL1
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5064
Practice Address - Country:US
Practice Address - Phone:319-369-7730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030462122300000X
IADDS-099671223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist