Provider Demographics
NPI:1245927672
Name:HAMMELMAN, DEREK BRIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:BRIAN
Last Name:HAMMELMAN
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 1:10699 DREXTON PL
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8795
Mailing Address - Country:US
Mailing Address - Phone:812-774-0020
Mailing Address - Fax:
Practice Address - Street 1:10699 DREXTON PL
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8795
Practice Address - Country:US
Practice Address - Phone:812-774-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE390200000X
IN12014114A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program