=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295103562
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY JONES HAMILTON DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2015
-----------------------------------------------------
Last Update Date | 09/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9900 LINCOLN STREET, 2ND FLOOR US ARMY DENTAC
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-968-4079
-----------------------------------------------------
Fax | 253-968-5919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9900 LINCOLN STREET, 2ND FLOOR, ATTN: CREDENTIALS OFFIC US ARMY DENTAC
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-968-4079
-----------------------------------------------------
Fax | 253-968-5919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 8629
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------