Provider Demographics
NPI:1245240373
Name:HAMILTON, JENNIFER M (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 QUINN DR
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2501
Mailing Address - Country:US
Mailing Address - Phone:608-849-9480
Mailing Address - Fax:608-849-3724
Practice Address - Street 1:1000 QUINN DR
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2501
Practice Address - Country:US
Practice Address - Phone:608-849-9480
Practice Address - Fax:608-849-3724
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4169-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist