Provider Demographics
NPI:1891858643
Name:HAMILTON-HALL, CHRISTINE LOUISE (DMD MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:HAMILTON-HALL
Suffix:
Gender:F
Credentials:DMD MD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:LOUISE
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:777 BOSTON POST ROAD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820
Mailing Address - Country:US
Mailing Address - Phone:203-656-4466
Mailing Address - Fax:203-656-4467
Practice Address - Street 1:777 BOSTON POST ROAD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820
Practice Address - Country:US
Practice Address - Phone:203-656-4466
Practice Address - Fax:203-656-4467
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0347451223S0112X
NY044504-1DENTIST204E00000X
NY192737-1PHYSICIAN204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002081628Medicaid
CT002081628Medicaid
G22202Medicare UPIN