Provider Demographics
NPI:1831301142
Name:MICHAEL L HAMANN DDS PA
Entity Type:Organization
Organization Name:MICHAEL L HAMANN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:HAMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-346-4775
Mailing Address - Street 1:200 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573-1495
Mailing Address - Country:US
Mailing Address - Phone:218-346-4775
Mailing Address - Fax:218-346-5775
Practice Address - Street 1:200 1ST AVE S
Practice Address - Street 2:
Practice Address - City:PERHAM
Practice Address - State:MN
Practice Address - Zip Code:56573-1495
Practice Address - Country:US
Practice Address - Phone:218-346-4775
Practice Address - Fax:218-346-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND7808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
989096OtherDENTAL SERVICE CORP
61165HAOtherBC BS
61165HAOtherBC BS