Provider Demographics
NPI:1124244595
Name:HAMER, LARRY V I (DDS)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:V
Last Name:HAMER
Suffix:I
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 1:3551 VIA DEL PRADO
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-5884
Mailing Address - Country:US
Mailing Address - Phone:818-648-5588
Mailing Address - Fax:
Practice Address - Street 1:800 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3374
Practice Address - Country:US
Practice Address - Phone:818-838-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice