Provider Demographics
NPI:1205450525
Name:HAMULA, DAVID WAYNE (DDS, MSD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:HAMULA
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 WOODMOOR DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9073
Mailing Address - Country:US
Mailing Address - Phone:719-488-3737
Mailing Address - Fax:719-488-5971
Practice Address - Street 1:1860 WOODMOOR DR STE 200
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9073
Practice Address - Country:US
Practice Address - Phone:719-488-3737
Practice Address - Fax:719-488-5971
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0055351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty