Provider Demographics
NPI:1831236470
Name:HAMLIN, JERRY WILLIS JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:WILLIS
Last Name:HAMLIN
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 ROCKEY CT
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2527
Mailing Address - Country:US
Mailing Address - Phone:850-207-9411
Mailing Address - Fax:
Practice Address - Street 1:FIRST DENTAL BATTALION NDC
Practice Address - Street 2:BUILDING 13128
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5221
Practice Address - Country:US
Practice Address - Phone:760-725-5208
Practice Address - Fax:760-725-5779
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0110011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice