Provider Demographics
NPI:1043220999
Name:HAMMERMAN, WILLARD JEFFREY (DDS, MAGD)
Entity Type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:JEFFREY
Last Name:HAMMERMAN
Suffix:
Gender:M
Credentials:DDS, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 SALAZAR RD STE 1
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-4103
Mailing Address - Country:US
Mailing Address - Phone:575-758-1100
Mailing Address - Fax:575-758-0705
Practice Address - Street 1:1027 SALAZAR RD STE 1
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-4103
Practice Address - Country:US
Practice Address - Phone:575-758-1100
Practice Address - Fax:575-758-0705
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2560122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist