Provider Demographics
NPI:1154412633
Name:HAMMAN, JOSEPH WAYNE (DDS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WAYNE
Last Name:HAMMAN
Suffix:
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 1:1900 USG DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5354
Mailing Address - Country:US
Mailing Address - Phone:847-362-3250
Mailing Address - Fax:
Practice Address - Street 1:1900 USG DR STE 110
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5354
Practice Address - Country:US
Practice Address - Phone:847-362-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice