Provider Demographics
NPI:1811332463
Name:HAMMER AND VANZANT FAMILY DENTISTRY PSC
Entity type:Organization
Organization Name:HAMMER AND VANZANT FAMILY DENTISTRY PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-737-8828
Mailing Address - Street 1:2405 RING ROAD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-737-8828
Mailing Address - Fax:270-763-8374
Practice Address - Street 1:2405 RING ROAD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-737-8828
Practice Address - Fax:270-763-8374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY75051223G0001X
KY51151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty