Provider Demographics
NPI:1295103562
Name:HAMILTON, MARY JONES (DMD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JONES
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 LINCOLN STREET, 2ND FLOOR, ATTN: CREDENTIALS OFFIC
Mailing Address - Street 2:US ARMY DENTAC
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98327
Mailing Address - Country:US
Mailing Address - Phone:253-968-4079
Mailing Address - Fax:253-968-5919
Practice Address - Street 1:9900 LINCOLN STREET, 2ND FLOOR
Practice Address - Street 2:US ARMY DENTAC
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98327
Practice Address - Country:US
Practice Address - Phone:253-968-4079
Practice Address - Fax:253-968-5919
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice