Provider Demographics
NPI:1306993191
Name:HAMILTON, KEVIN MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
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 1:202 S. HOLLY STREET
Mailing Address - Street 2:
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633
Mailing Address - Country:US
Mailing Address - Phone:337-786-2146
Mailing Address - Fax:337-786-2874
Practice Address - Street 1:202 S. HOLLY STREET
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633
Practice Address - Country:US
Practice Address - Phone:337-786-2146
Practice Address - Fax:337-786-2874
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229861223G0001X
LA49651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice