Provider Demographics
NPI:1114135381
Name:HAMBLETON, JEFFREY CRAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CRAIG
Last Name:HAMBLETON
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 1:1440 WAKARUSA DR
Mailing Address - Street 2:STE 300
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4090
Mailing Address - Country:US
Mailing Address - Phone:785-841-1188
Mailing Address - Fax:785-841-1469
Practice Address - Street 1:1440 WAKARUSA DR
Practice Address - Street 2:STE 300
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4090
Practice Address - Country:US
Practice Address - Phone:785-841-1188
Practice Address - Fax:785-841-1469
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54401223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics