Provider Demographics
NPI:1356483010
Name:HAMPTON, MARK EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:HAMPTON
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:P.O. BOX 896
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431
Mailing Address - Country:US
Mailing Address - Phone:352-489-5071
Mailing Address - Fax:352-489-4293
Practice Address - Street 1:11902 ILLINOIS ST.
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34431
Practice Address - Country:US
Practice Address - Phone:352-489-5071
Practice Address - Fax:352-489-4293
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL107591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL67509OtherBCBS OF FL
FL10759OtherSTATE LICENSE
FL608704OtherUNITED CONCORDIA
FLUCCI608704OtherDELTA