Healthcare Provider Details

I. General information

NPI: 1770546954
Provider Name (Legal Business Name): JOHN ERIC HAMMEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 VEACH RD
OWENSBORO KY
42303-6295
US

IV. Provider business mailing address

2816 VEACH ROAD
OWENSBORO KY
42303-6295
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-6100
  • Fax: 270-926-6195
Mailing address:
  • Phone: 270-926-6100
  • Fax: 270-926-6195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8320
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8320
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: