Provider Demographics
NPI:1003824830
Name:HAMMERMEISTER, NICHOLAS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:L
Last Name:HAMMERMEISTER
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 1:8961 STATE ROUTE 14 UNIT B
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5625
Mailing Address - Country:US
Mailing Address - Phone:330-422-1400
Mailing Address - Fax:330-422-1460
Practice Address - Street 1:8961 STATE ROUTE 14 UNIT B
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5625
Practice Address - Country:US
Practice Address - Phone:330-422-1400
Practice Address - Fax:330-422-1460
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH20-1710440OtherTAX ID #
OH2135040Medicaid
OH30. 021019OtherSTATE LICENSE #
OH30. 021019OtherSTATE LICENSE #
OH2135040Medicaid
OHU78789Medicare UPIN