Healthcare Provider Details

I. General information

NPI: 1083028773
Provider Name (Legal Business Name): CHRISTINE LOUISE HAMMER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4765 CARMEL MOUNTAIN RD STE 210
SAN DIEGO CA
92130-6657
US

IV. Provider business mailing address

4765 CARMEL MOUNTAIN RD STE 210
SAN DIEGO CA
92130-6657
US

V. Phone/Fax

Practice location:
  • Phone: 858-755-9511
  • Fax: 858-755-8511
Mailing address:
  • Phone: 858-755-9511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15475
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number33484
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number105105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: