Healthcare Provider Details

I. General information

NPI: 1700240512
Provider Name (Legal Business Name): HEATHER WASHBURN HAMMOND D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. HEATHER ELIZABETH WASHBURN

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 EVERGREEN RD STE 100
LOUISVILLE KY
40243-1480
US

IV. Provider business mailing address

5100 OUTER LOOP STE C
LOUISVILLE KY
40219-3023
US

V. Phone/Fax

Practice location:
  • Phone: 502-410-1710
  • Fax:
Mailing address:
  • Phone: 502-969-9264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12012555A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9801
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: