Healthcare Provider Details

I. General information

NPI: 1316229347
Provider Name (Legal Business Name): MARINA V HAMPTON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 N BUTLER AVE
FARMINGTON NM
87401-4201
US

IV. Provider business mailing address

4310 MORNING STAR DR
FARMINGTON NM
87401-8815
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-5057
  • Fax: 505-327-0330
Mailing address:
  • Phone: 956-336-9630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4454
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number27451
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: