Healthcare Provider Details

I. General information

NPI: 1245238666
Provider Name (Legal Business Name): GARY JAMES HAMMOND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2005
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 ROUTE 120 UNIT E1
LEBANON NH
03766
US

IV. Provider business mailing address

367 ROUTE 120 UNIT E1
LEBANON NH
03766-1430
US

V. Phone/Fax

Practice location:
  • Phone: 603-643-1700
  • Fax: 603-643-1702
Mailing address:
  • Phone: 603-643-1700
  • Fax: 603-643-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD3869
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number03746
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: