Provider Demographics
NPI:1124101787
Name:HAMMER AND BRECHON DDS PC
Entity type:Organization
Organization Name:HAMMER AND BRECHON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-684-8636
Mailing Address - Street 1:1302 N ELM ST
Mailing Address - Street 2:OTTUMWA IA 52501
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501
Mailing Address - Country:US
Mailing Address - Phone:641-684-8636
Mailing Address - Fax:641-684-0686
Practice Address - Street 1:1302 N ELM ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501
Practice Address - Country:US
Practice Address - Phone:641-684-8636
Practice Address - Fax:641-684-0686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
IA4841122300000X
IA7691122300000X
IA7799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0050442Medicaid
IA0105569Medicaid
IA0128546Medicaid
IA52241OtherBLUE CROSS BLUE SHIELD