Provider Demographics
NPI:1184006538
Name:HAMM, TREVOR AUSTIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:AUSTIN
Last Name:HAMM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SE 42ND TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-8323
Mailing Address - Country:US
Mailing Address - Phone:815-274-5516
Mailing Address - Fax:
Practice Address - Street 1:1001 S LOOP BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6028
Practice Address - Country:US
Practice Address - Phone:239-369-5897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist