Healthcare Provider Details

I. General information

NPI: 1174588941
Provider Name (Legal Business Name): ANN HAMMI-BLUE D.D.S., M.S., P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7725 N 43RD AVE SUITE 724
PHOENIX AZ
85051-5770
US

IV. Provider business mailing address

7725 N 43RD AVE SUITE 724
PHOENIX AZ
85051-5770
US

V. Phone/Fax

Practice location:
  • Phone: 623-934-1676
  • Fax: 623-934-6630
Mailing address:
  • Phone: 623-934-1676
  • Fax: 623-934-6630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD5379
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: