Provider Demographics
NPI:1740612076
Name:HAMMOND, SHANDA MAE (RDH, BS)
Entity Type:Individual
Prefix:MRS
First Name:SHANDA
Middle Name:MAE
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2779 STAGE COACH DR
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:CO
Mailing Address - Zip Code:80542-4021
Mailing Address - Country:US
Mailing Address - Phone:303-514-9344
Mailing Address - Fax:
Practice Address - Street 1:1805 HIGHWAY 42
Practice Address - Street 2:SUITE 120
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2505
Practice Address - Country:US
Practice Address - Phone:303-666-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905706124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5638762Medicaid