Provider Demographics
NPI:1073744306
Name:E. M. HAMMON, JR., D. D.S., P.C.
Entity Type:Organization
Organization Name:E. M. HAMMON, JR., D. D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ENOCH
Authorized Official - Middle Name:MATISON
Authorized Official - Last Name:HAMMON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-667-1038
Mailing Address - Street 1:4841 HIXSON PIKE
Mailing Address - Street 2:SUITE E
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4431
Mailing Address - Country:US
Mailing Address - Phone:423-877-5242
Mailing Address - Fax:423-877-5261
Practice Address - Street 1:4841 HIXSON PIKE
Practice Address - Street 2:SUITE E
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4431
Practice Address - Country:US
Practice Address - Phone:423-877-5242
Practice Address - Fax:423-877-5261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN01872122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3224981Medicare UPIN