Healthcare Provider Details

I. General information

NPI: 1194932954
Provider Name (Legal Business Name): EMORY E. HAMILTON DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 E BARNETT RD
MEDFORD OR
97504-8309
US

IV. Provider business mailing address

2930 E BARNETT RD
MEDFORD OR
97504-8309
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-4501
  • Fax: 547-779-8674
Mailing address:
  • Phone: 541-779-4501
  • Fax: 547-779-8674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD3962
License Number StateOR

VIII. Authorized Official

Name: DR. EMORY E HAMILTON
Title or Position: OWNER
Credential: DMD
Phone: 541-779-4501