MEDICARE: TODD L HAMILTON DDS PA

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	5217	NC

General Provider Information

NPI Number	:	1457799223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TODD L HAMILTON DDS PA

Provider Business Mailing Address
First Line	:	7482 WATERSIDE CROSSING BLVD
Second Line	:	SUITE 201
City	:	DENVER
State	:	NC
Zip	:	28037-3005
Country	:	US
Telephone Number	:	704-822-0320
Fax Number	:	704-822-8097

Provider Business Practice Location Address
First Line	:	7482 WATERSIDE CROSSING BLVD
Second Line	:	SUITE 201
City	:	DENVER
State	:	NC
Zip	:	28037-3005
Country	:	US
Telephone Number	:	704-822-0320
Fax Number	:	704-822-8097

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TODD LELAND HAMILTON
Credential	:	DDS
Telephone Number	:	704-779-9793

Provider Enumeration Date	:	06/13/2013
Last Update Date	:	06/13/2013

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