Healthcare Provider Details

I. General information

NPI: 1962494559
Provider Name (Legal Business Name): MARTIN J HAMILTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 BODIN CIR
TRAVIS AFB CA
94535-1801
US

IV. Provider business mailing address

151 BODIN CIR
TRAVIS AFB CA
94535-1801
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number034849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: