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General NPI Number Information
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NPI Number | 1184054587
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Entity Type | Organization
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Legal Business Name | HAMILTON PEDIATRIC DENTISTRY PC
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Dates
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Enumeration Date | 11/21/2013
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 3299 CLEAR VISTA CT NE SUITE B
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9326
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Country | US
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Telephone | 919-308-6292
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Fax |
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Provider Business Mailing Address
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Address Line | 3299 CLEAR VISTA CT NE SUITE B
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9326
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | DR. VERONICA R HAMILTON
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Credential | DDS, MS
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Telephone | 919-308-6292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2901020854
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License Number State | MI
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