Provider Demographics
NPI:1003983271
Name:HAMLIN, LARRY EUGENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:EUGENE
Last Name:HAMLIN
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 1:135 SUDDITH STREET
Mailing Address - Street 2:PO BOX 635
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360
Mailing Address - Country:US
Mailing Address - Phone:606-674-6305
Mailing Address - Fax:606-674-6306
Practice Address - Street 1:135 SUDDITH STREET
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360
Practice Address - Country:US
Practice Address - Phone:606-674-6305
Practice Address - Fax:606-674-6306
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60041191Medicaid