Provider Demographics
NPI:1851412738
Name:HAMILTON, MICHAEL B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9090 SKILLMAN ST
Mailing Address - Street 2:SUITE 200C
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8259
Mailing Address - Country:US
Mailing Address - Phone:214-342-5757
Mailing Address - Fax:214-340-4868
Practice Address - Street 1:1111 S IRVING HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-6261
Practice Address - Country:US
Practice Address - Phone:972-445-3600
Practice Address - Fax:972-785-1223
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22734122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1479404-11Medicaid
TX1479404-06Medicaid
TX1801946-01Medicaid
TX1479404-03Medicaid
TX1479404-07Medicaid
TX1801946-02Medicaid
TX1801946-03Medicaid
TX1479404-05Medicaid
TX1801946-04Medicaid
TX1479404-04Medicaid
TX1479404-09Medicaid
TX1479404-10Medicaid
TX1801946-05Medicaid
TX1479404-01Medicaid
TX1479404-08Medicaid
TX1479404-12Medicaid