Provider Demographics
NPI:1194891648
Name:HAMILTON, JOHN WILMONT (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILMONT
Last Name:HAMILTON
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 1:2204 2ND AVE W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3485
Mailing Address - Country:US
Mailing Address - Phone:701-774-8822
Mailing Address - Fax:701-774-8823
Practice Address - Street 1:2204 2ND AVE W
Practice Address - Street 2:SUITE 101
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3485
Practice Address - Country:US
Practice Address - Phone:701-774-8822
Practice Address - Fax:701-774-8823
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND15471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40596Medicaid