Provider Demographics
NPI:1306151873
Name:HAMMELMAN, LAVONNE MARIE (DMD)
Entity type:Individual
Prefix:
First Name:LAVONNE
Middle Name:MARIE
Last Name:HAMMELMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 682
Mailing Address - Street 2:
Mailing Address - City:HALFWAY
Mailing Address - State:OR
Mailing Address - Zip Code:97834-0682
Mailing Address - Country:US
Mailing Address - Phone:541-742-6012
Mailing Address - Fax:
Practice Address - Street 1:218 N PINE ST
Practice Address - Street 2:
Practice Address - City:HALFWAY
Practice Address - State:OR
Practice Address - Zip Code:97834
Practice Address - Country:US
Practice Address - Phone:541-742-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD110561223G0001X
WADE60153590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist