MEDICARE: DR. HAYWOOD LEE HAMBRICK DDS

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	122300000X	Dentist	012136591	MO
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	012136591	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2181	OTHER	DURAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00759025	OTHER	BLUE CROSS

General Provider Information

NPI Number	:	1447386206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAYWOOD LEE HAMBRICK DDS

Provider Business Mailing Address
First Line	:	1115 EAST 65TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1202
Country	:	US
Telephone Number	:	816-523-7766
Fax Number	:	816-523-2263

Provider Business Practice Location Address
First Line	:	1115 EAST 65TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1202
Country	:	US
Telephone Number	:	816-523-7766
Fax Number	:	816-523-2263

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	05/22/2013

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