IndividualActive
Jonathan Hanson, D.D.S.
NPI 1518073402 · Oral and Maxillofacial Surgery (Dentist) · Jefferson City, MO
Provider details
- NPI number
- 1518073402
- Entity type
- Individual
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Credential
- D.D.S.
- Sex
- Male
- Sole proprietor
- No
- License
- 011885 (MO)
Specialties & taxonomies
Dental Providers
Practice location
1400 Southwest Blvd
Suite C
Jefferson City, MO 65109-2490
Phone: (573) 635-7216
Fax: (573) 635-2646
Approximate (ZIP-level) locationGet directions
Mailing address
1400 Southwest Blvd
Jefferson City, MO 65109-2490
Registry dates
- Enumerated
- 2006-08-22
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.