=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174588941
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN HAMMI-BLUE D.D.S., M.S., P.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7725 N 43RD AVE SUITE 724
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85051-5770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-934-1676
-----------------------------------------------------
Fax | 623-934-6630
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7725 N 43RD AVE SUITE 724
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85051-5770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-934-1676
-----------------------------------------------------
Fax | 623-934-6630
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | D5379
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------