Provider Demographics
NPI:1912086265
Name:ROBERT B HAMMOND, DDS, PA
Entity Type:Organization
Organization Name:ROBERT B HAMMOND, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-258-1940
Mailing Address - Street 1:624 S RIDGEWOOD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-3703
Mailing Address - Country:US
Mailing Address - Phone:386-258-1940
Mailing Address - Fax:386-258-1941
Practice Address - Street 1:624 S RIDGEWOOD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3703
Practice Address - Country:US
Practice Address - Phone:386-258-1940
Practice Address - Fax:386-258-1941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty