Provider Demographics
NPI:1407029440
Name:MELISSA A HAMILTON, DMD, INC.
Entity Type:Organization
Organization Name:MELISSA A HAMILTON, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-880-8860
Mailing Address - Street 1:35 SUMMER ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3469
Mailing Address - Country:US
Mailing Address - Phone:508-880-8860
Mailing Address - Fax:508-880-8873
Practice Address - Street 1:35 SUMMER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3469
Practice Address - Country:US
Practice Address - Phone:508-880-8860
Practice Address - Fax:508-880-8873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21128204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX20143Medicaid
MAX20143Medicaid