Provider Demographics
NPI:1275789257
Name:HAMMEL, KATHRINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHRINE
Middle Name:
Last Name:HAMMEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KATHRINE
Other - Middle Name:
Other - Last Name:HAMMELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5717 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2401
Mailing Address - Country:US
Mailing Address - Phone:520-647-2888
Mailing Address - Fax:520-647-2889
Practice Address - Street 1:5717 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2401
Practice Address - Country:US
Practice Address - Phone:520-647-2888
Practice Address - Fax:520-647-2889
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD07590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ352273Medicaid