Provider Demographics
NPI:1720789845
Name:HAMPTON COVE PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:HAMPTON COVE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-826-7909
Mailing Address - Street 1:6511 HIGHWAY 431 S STE B
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9217
Mailing Address - Country:US
Mailing Address - Phone:256-210-1775
Mailing Address - Fax:256-210-1947
Practice Address - Street 1:6511 HIGHWAY 431 S STE B
Practice Address - Street 2:
Practice Address - City:OWENS CROSS ROADS
Practice Address - State:AL
Practice Address - Zip Code:35763-9217
Practice Address - Country:US
Practice Address - Phone:256-210-1775
Practice Address - Fax:256-210-1947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty