Provider Demographics
NPI:1992847438
Name:HAMMACK, ERIC SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:SCOTT
Last Name:HAMMACK
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 1:119 WEST BRIDGE
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-2800
Mailing Address - Country:US
Mailing Address - Phone:580-363-4245
Mailing Address - Fax:580-363-0082
Practice Address - Street 1:119 WEST BRIDGE
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-2800
Practice Address - Country:US
Practice Address - Phone:580-363-4245
Practice Address - Fax:580-363-0082
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice