Healthcare Provider Details

I. General information

NPI: 1306151873
Provider Name (Legal Business Name): LAVONNE MARIE HAMMELMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 N PINE ST
HALFWAY OR
97834
US

IV. Provider business mailing address

PO BOX 682
HALFWAY OR
97834-0682
US

V. Phone/Fax

Practice location:
  • Phone: 541-742-6012
  • Fax:
Mailing address:
  • Phone: 541-742-6012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60153590
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD11056
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: