Provider Demographics
NPI:1205009933
Name:HAMMOND, RONALD JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOHN
Last Name:HAMMOND
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 1:556 TREJO ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2625
Mailing Address - Country:US
Mailing Address - Phone:208-359-2224
Mailing Address - Fax:208-359-2250
Practice Address - Street 1:556 TREJO ST
Practice Address - Street 2:SUITE C
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-2625
Practice Address - Country:US
Practice Address - Phone:208-359-2224
Practice Address - Fax:208-359-2250
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD18001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice