Provider Demographics
NPI: | 1821385816 |
---|---|
Name: | HAMMOCKS DENTAL GROUP PA |
Entity Type: | Organization |
Organization Name: | HAMMOCKS DENTAL GROUP PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DENTIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ERIK |
Authorized Official - Middle Name: | O |
Authorized Official - Last Name: | CALDERON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD |
Authorized Official - Phone: | 305-387-5700 |
Mailing Address - Street 1: | 9280 HAMMOCKS BLVD. |
Mailing Address - Street 2: | SUITE 102 |
Mailing Address - City: | MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33196-1594 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-387-5700 |
Mailing Address - Fax: | 305-387-6566 |
Practice Address - Street 1: | 9280 HAMMOCKS BLVD. |
Practice Address - Street 2: | SUITE 102 |
Practice Address - City: | MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33196-1594 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-387-5700 |
Practice Address - Fax: | 305-387-6566 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-06-29 |
Last Update Date: | 2011-06-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | DN19377 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Multi-Specialty |