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General NPI Number Information
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NPI Number | 1699858126
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Entity Type | Organization
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Legal Business Name | JACK N HAMILTON DMD MS INC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 72 880 FRED WARING DR STE D 16
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City | PALM DESERT
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State | CA
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Zip | 92260
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Country | US
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Telephone | 760-568-3421
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Fax | 760-568-0731
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Provider Business Mailing Address
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Address Line | 72 880 FRED WARING DR STE D 16
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City | PALM DESERT
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State | CA
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Zip | 92260
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Country | US
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Telephone | 760-568-3421
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Fax | 760-568-0731
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK N HAMILTON
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Credential | DMD MS
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Telephone | 760-568-3421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 26415
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License Number State | CA
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