=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063578086
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL A. HAMERSKY D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2006
-----------------------------------------------------
Last Update Date | 05/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9227 EAST LINCOLN AVE. SUITE #100
-----------------------------------------------------
City | LONE TREE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80124-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-344-2662
-----------------------------------------------------
Fax | 720-344-2663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9227 EAST LINCOLN AVE. SUITE #100
-----------------------------------------------------
City | LONE TREE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80124-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-344-2662
-----------------------------------------------------
Fax | 720-344-2663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 4397
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------