Provider Demographics
NPI:1578572202
Name:HAMANN, MICHAEL L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:HAMANN
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 1:200 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573
Mailing Address - Country:US
Mailing Address - Phone:218-346-4775
Mailing Address - Fax:218-346-5775
Practice Address - Street 1:200 1ST AVE S
Practice Address - Street 2:
Practice Address - City:PERHAM
Practice Address - State:MN
Practice Address - Zip Code:56573
Practice Address - Country:US
Practice Address - Phone:218-346-4775
Practice Address - Fax:218-346-5775
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
41131921X241OtherDELTA
611T5HAOtherBLUE CROSS BLUE SHIELD
9X9096OtherDENTAL SERVICE CORP