Provider Demographics
NPI:1679684005
Name:HAMMON, ENOCH MATISON JR (D D S)
Entity Type:Individual
Prefix:DR
First Name:ENOCH
Middle Name:MATISON
Last Name:HAMMON
Suffix:JR
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 LOWER MILL RD
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-2908
Mailing Address - Country:US
Mailing Address - Phone:423-842-2723
Mailing Address - Fax:
Practice Address - Street 1:4841 HIXSON PIKE STE E
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4431
Practice Address - Country:US
Practice Address - Phone:423-877-5242
Practice Address - Fax:423-877-5261
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN018721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3224981Medicare ID - Type Unspecified