MEDICARE: DR. H M HAMILTON II 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	1223G0001X	General Practice Dentistry	4551	LA

General Provider Information

NPI Number	:	1649471053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. H M HAMILTON II DDS

Provider Business Mailing Address
First Line	:	406 W MCNEESE ST
Second Line	:	B
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5526
Country	:	US
Telephone Number	:	337-477-9790
Fax Number	:	337-477-9792

Provider Business Practice Location Address
First Line	:	406 W MCNEESE ST
Second Line	:	B
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5526
Country	:	US
Telephone Number	:	337-477-9790
Fax Number	:	337-477-9792

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	08/19/2008

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