Healthcare Provider Details

I. General information

NPI: 1497115224
Provider Name (Legal Business Name): DR. MARINA HAMPTON DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
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

2050 N BUTLER AVE
FARMINGTON NM
87401-4201
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4454
License Number StateNM

VIII. Authorized Official

Name: MARINA VOLKOVA HAMPTON
Title or Position: DENTIST
Credential: DDS
Phone: 505-327-5057