Provider Demographics
NPI:1891765731
Name:HAMILTON, BRENDA R (DMD, MS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:R
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:DMD, MS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 SCOTLAND YARD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5914
Mailing Address - Country:US
Mailing Address - Phone:904-305-8555
Mailing Address - Fax:
Practice Address - Street 1:14866 OLD SAINT AUGUSTINE RD STE 111
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2611
Practice Address - Country:US
Practice Address - Phone:904-342-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN266881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics