Provider Demographics
NPI:1265050504
Name:HAMMOCK, DMD & LOTAKIS, DDS X, PLLC
Entity type:Organization
Organization Name:HAMMOCK, DMD & LOTAKIS, DDS X, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-975-1110
Mailing Address - Street 1:5821 FAIRVIEW RD STE 220
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-5601
Mailing Address - Country:US
Mailing Address - Phone:704-522-1550
Mailing Address - Fax:
Practice Address - Street 1:9201 S TRYON ST STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4239
Practice Address - Country:US
Practice Address - Phone:704-588-1627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental