Provider Demographics
NPI:1629237342
Name:HAMANN, BRIAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
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 1:301 ALLEN ST PO BOX 78
Mailing Address - Street 2:GENTLE FAMILY DENTISTRY
Mailing Address - City:CLINTON
Mailing Address - State:WI
Mailing Address - Zip Code:53525
Mailing Address - Country:US
Mailing Address - Phone:608-676-5415
Mailing Address - Fax:608-676-5733
Practice Address - Street 1:301 ALLEN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WI
Practice Address - Zip Code:53525
Practice Address - Country:US
Practice Address - Phone:608-676-5415
Practice Address - Fax:608-676-5733
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice