Provider Demographics
NPI:1194861757
Name:CLARK HAMILTON DDS PA
Entity Type:Organization
Organization Name:CLARK HAMILTON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-321-2714
Mailing Address - Street 1:430 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301
Mailing Address - Country:US
Mailing Address - Phone:850-321-2714
Mailing Address - Fax:850-224-3242
Practice Address - Street 1:430 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301
Practice Address - Country:US
Practice Address - Phone:850-321-2714
Practice Address - Fax:850-224-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN3128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty