Provider Demographics
NPI:1538255757
Name:HANSEN, JAY D (DDS)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:D
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 1:7270 RACHEL RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1023
Mailing Address - Country:US
Mailing Address - Phone:402-380-1155
Mailing Address - Fax:
Practice Address - Street 1:989375 NEBRASKA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198
Practice Address - Country:US
Practice Address - Phone:402-559-6000
Practice Address - Fax:402-559-9607
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE54061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-069639100Medicaid