Provider Demographics
NPI:1568686780
Name:HAMILTON, CLIVE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIVE
Middle Name:L
Last Name:HAMILTON
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 1:361 BIRD STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605
Mailing Address - Country:US
Mailing Address - Phone:203-330-6000
Mailing Address - Fax:203-339-7912
Practice Address - Street 1:361 BIRD ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-2804
Practice Address - Country:US
Practice Address - Phone:203-330-6000
Practice Address - Fax:203-339-7912
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0090281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice