Healthcare Provider Details

I. General information

NPI: 1477685626
Provider Name (Legal Business Name): TERRENCE THADDEUS HAMPTON DMD DENTIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W MAIN ST
MARLOW OK
73055
US

IV. Provider business mailing address

PO BOX 606 409 W MAIN ST
MARLOW OK
73055
US

V. Phone/Fax

Practice location:
  • Phone: 580-658-3619
  • Fax: 580-658-3619
Mailing address:
  • Phone: 580-658-3619
  • Fax: 580-658-3619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3105
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: