Provider Demographics
NPI:1942583497
Name:HAMRIC, ROBERT EDMONDSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDMONDSON
Last Name:HAMRIC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 WELLINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-4846
Mailing Address - Country:US
Mailing Address - Phone:205-967-5009
Mailing Address - Fax:205-969-2104
Practice Address - Street 1:3100 WELLINGTON PKWY
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-4846
Practice Address - Country:US
Practice Address - Phone:205-967-5009
Practice Address - Fax:205-969-2104
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3100Medicaid