Provider Demographics
NPI:1003375494
Name:HAME DENTAL GROUP
Entity Type:Organization
Organization Name:HAME DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EWA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-304-7474
Mailing Address - Street 1:31537 RANCHO PUEBLO RD STE 205
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4841
Mailing Address - Country:US
Mailing Address - Phone:951-304-7474
Mailing Address - Fax:951-304-7473
Practice Address - Street 1:31537 RANCHO PUEBLO RD STE 205
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4841
Practice Address - Country:US
Practice Address - Phone:951-304-7474
Practice Address - Fax:951-304-7473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty