Provider Demographics
NPI:1710103197
Name:HAMPTON, PHILLIP DERRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:DERRICK
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-0650
Mailing Address - Country:US
Mailing Address - Phone:478-275-2664
Mailing Address - Fax:478-275-2665
Practice Address - Street 1:2400 BELLEVUE RD
Practice Address - Street 2:# 24 ERIN OFFICE PARK
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2885
Practice Address - Country:US
Practice Address - Phone:478-275-2664
Practice Address - Fax:478-275-2665
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10895122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist