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General NPI Number Information
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NPI Number | 1265050504
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Entity Type | Organization
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Legal Business Name | HAMMOCK, DMD & LOTAKIS, DDS X, PLLC
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 9201 S TRYON ST STE A
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City | CHARLOTTE
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State | NC
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Zip | 28273-4239
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Country | US
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Telephone | 704-588-1627
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Fax |
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Provider Business Mailing Address
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Address Line | 5821 FAIRVIEW RD STE 220
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City | CHARLOTTE
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State | NC
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Zip | 28209-5601
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Country | US
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Telephone | 704-522-1550
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | CLARK HAMMOCK
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Credential | DMD
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Telephone | 704-975-1110
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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 |
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License Number State |
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