MEDICARE: HAYWOOD L HAMBRICK, D.D.S. INC

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	012136 / 591	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2181	OTHER	MO	DORAL
2	609100	OTHER	MO	BRIDGEPORT
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790950582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAYWOOD L HAMBRICK, D.D.S. INC

Provider Business Mailing Address
First Line	:	1115 E 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 STREET
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	:	OWNER
Name	:	DR. HAYWOOD LEE HAMBRICK
Credential	:	D D S
Telephone Number	:	816-523-7766

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/23/2008

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