MEDICARE: DR. JOHN WILMONT HAMILTON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1547	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194891648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WILMONT HAMILTON D.D.S.

Provider Business Mailing Address
First Line	:	2204 2ND AVE W
Second Line	:	SUITE 101
City	:	WILLISTON
State	:	ND
Zip	:	58801-3485
Country	:	US
Telephone Number	:	701-774-8822
Fax Number	:	701-774-8823

Provider Business Practice Location Address
First Line	:	2204 2ND AVE W
Second Line	:	SUITE 101
City	:	WILLISTON
State	:	ND
Zip	:	58801-3485
Country	:	US
Telephone Number	:	701-774-8822
Fax Number	:	701-774-8823

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/09/2007

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