Provider Demographics
NPI:1477094852
Name:OAK HAVEN DENTAL
Entity Type:Organization
Organization Name:OAK HAVEN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-857-2020
Mailing Address - Street 1:203 E MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4350
Mailing Address - Country:US
Mailing Address - Phone:307-857-2020
Mailing Address - Fax:307-857-2727
Practice Address - Street 1:203 E MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4350
Practice Address - Country:US
Practice Address - Phone:307-857-2020
Practice Address - Fax:307-857-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY14351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty