Provider Demographics
NPI:1194123463
Name:HAMMONS DENTAL, PC
Entity type:Organization
Organization Name:HAMMONS DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-628-6644
Mailing Address - Street 1:2107 W SUNSET BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7139
Mailing Address - Country:US
Mailing Address - Phone:435-628-6644
Mailing Address - Fax:
Practice Address - Street 1:2107 W SUNSET BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7139
Practice Address - Country:US
Practice Address - Phone:435-628-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT66148311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty