Provider Demographics
NPI:1073070728
Name:HAMMOCK, DMD & LOTAKIS, DDS IV, PLLC
Entity Type:Organization
Organization Name:HAMMOCK, DMD & LOTAKIS, DDS IV, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP - ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-522-1550
Mailing Address - Street 1:5821 FAIRVIEW RD STE 220
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-5601
Mailing Address - Country:US
Mailing Address - Phone:704-522-1550
Mailing Address - Fax:704-445-7895
Practice Address - Street 1:2258 W ROOSEVELT BLVD STE A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-3090
Practice Address - Country:US
Practice Address - Phone:704-291-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty