Provider Demographics
NPI:1164739355
Name:HAMILTON, LEVI ANDREW (DDS)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:ANDREW
Last Name:HAMILTON
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 1:293 N SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-1660
Mailing Address - Country:US
Mailing Address - Phone:937-382-2042
Mailing Address - Fax:937-382-8936
Practice Address - Street 1:293 N SOUTH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-1660
Practice Address - Country:US
Practice Address - Phone:937-382-2042
Practice Address - Fax:937-382-8936
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist