BRYCE D HANSON, D.M.D — NPI 1629027099 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in SHELLEY, ID)

CMS-1500 Box 24J / 33a • NPI

1629027099

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

122300000X (CMS C5)

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

371 W FIR ST, SHELLEY, ID, 83274-1456

✓ 9-Digit EDI 837 ZIP+4 (83274-1456)

Practice Phone & Referral Fax

(208) 357-7611

Fax: (208) 357-1805

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1629027099 (BRYCE D HANSON, D.M.D) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1629027099` (NPI-1 Individual Practitioner)
Provider / Legal Name	BRYCE D HANSON, D.M.D
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `122300000X` (Dentist)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	371 W FIR ST, SHELLEY, ID, 83274-1456
Practice Telephone / Fax	Tel: (208) 357-7611 \| Fax: (208) 357-1805
Administrative Mailing Address	PO BOX 525, SHELLEY, ID, 83274-0525
Enumeration & Last Sync	Enumerated: 2006-05-10 \| CMS Record Updated: 2023-10-12

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

371 W FIR ST, SHELLEY, ID, 83274-1456

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Plain-English Taxonomy & CMS Crosswalk (122300000X)

What Does Taxonomy Code 122300000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 122300000X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code C5 (Dentist)
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BRYCE D HANSON, D.M.D)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`122300000X` — Dentist Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: ID \| License: `D-3275` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BRYCE D HANSON, D.M.D (NPI #1629027099)