Provider Demographics
NPI:1861916231
Name:HANSEN, RACHEL DIANE (RDH)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:DIANE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 CLARK FORK WAY APT 309
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5471
Mailing Address - Country:US
Mailing Address - Phone:406-529-1114
Mailing Address - Fax:
Practice Address - Street 1:2901 BROOKS ST STE A1
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7723
Practice Address - Country:US
Practice Address - Phone:406-541-2886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13486124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist