Provider Demographics
NPI:1366486524
Name:HAMMOND, KEITH DAINES (DDS)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:DAINES
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 1:290 N 200 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4488
Mailing Address - Country:US
Mailing Address - Phone:435-753-0505
Mailing Address - Fax:435-753-8524
Practice Address - Street 1:290 N 200 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4488
Practice Address - Country:US
Practice Address - Phone:435-753-0505
Practice Address - Fax:435-753-8524
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13453999221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice