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General NPI Number Information
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NPI Number | 1730305111
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Entity Type | Organization
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Legal Business Name | LARRY V. HAMER, D.D.S. PROF CORP
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 800 SAN FERNANDO RD
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City | SAN FERNANDO
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State | CA
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Zip | 91340-3374
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Country | US
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Telephone | 818-183-8660
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Fax |
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Provider Business Mailing Address
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Address Line | 777TRUMAN ST., SUITE 107
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City | SAN FERNANDO
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State | CA
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Zip | 91340-3374
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Country | US
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Telephone | 818-183-8660
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LARRY HAMER
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Credential | D.D.S.
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Telephone | 818-838-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 43604
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License Number State | CA
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