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
StateLicense IDTaxonomies
FLDN19377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty