Provider Demographics
NPI:1366573842
Name:HAMILTON, JEFFREY D (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
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 1:1800 COOPER PT RD SW
Mailing Address - Street 2:BLDG 23
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1179
Mailing Address - Country:US
Mailing Address - Phone:360-352-1330
Mailing Address - Fax:360-357-8452
Practice Address - Street 1:1800 COOPER PT RD SW
Practice Address - Street 2:BLDG 23
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1179
Practice Address - Country:US
Practice Address - Phone:360-352-1330
Practice Address - Fax:360-357-8452
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000047431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA05351OtherWDS
90998OtherLABOR & INDUSTRIES
WAHA3070OtherREGENCE BSBC
WA5025895Medicare ID - Type UnspecifiedDSHS