Provider Demographics
NPI:1427071661
Name:HAMMON, COLIN KIPP (DMD)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:KIPP
Last Name:HAMMON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:COLIN
Other - Middle Name:KIPP
Other - Last Name:HAMMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:330 S GARDEN WAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-686-9750
Mailing Address - Fax:541-485-5034
Practice Address - Street 1:330 S GARDEN WAY
Practice Address - Street 2:SUITE 140
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-686-9750
Practice Address - Fax:541-485-5034
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD60731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR190003094OtherPALMETTO
OR212142Medicaid
00WCMBFBMedicare PIN
ORU24945Medicare UPIN
OR190003094OtherPALMETTO
OR212142Medicaid