Provider Demographics
NPI:1013512896
Name:HAMM DENTISTRY, LLC
Entity Type:Organization
Organization Name:HAMM DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELBY
Authorized Official - Middle Name:K
Authorized Official - Last Name:FUJII
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-673-3355
Mailing Address - Street 1:1313 W HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2838
Mailing Address - Country:US
Mailing Address - Phone:541-673-3355
Mailing Address - Fax:541-673-1533
Practice Address - Street 1:1313 W HARVARD AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2838
Practice Address - Country:US
Practice Address - Phone:541-673-3355
Practice Address - Fax:541-673-1533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500769119Medicaid
OR226860Medicaid