Provider Demographics
NPI:1003477159
Name:HAMREN, DUSTIN JOHN (DMD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JOHN
Last Name:HAMREN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2782 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-1469
Mailing Address - Country:US
Mailing Address - Phone:828-267-6858
Mailing Address - Fax:828-267-6860
Practice Address - Street 1:2782 2ND ST NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-1469
Practice Address - Country:US
Practice Address - Phone:828-267-6858
Practice Address - Fax:828-267-6860
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC114761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice