=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891981312
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL M HAMILTON DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2007
-----------------------------------------------------
Last Update Date | 09/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 987 PROVIDENCE SQ SHOPPING CTR
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23464-4301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-495-2100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3180 STONEWOOD DR
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23456-1561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-721-9720
-----------------------------------------------------
Fax | 757-721-9276
-----------------------------------------------------
=====================================================
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 | 0401411332
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------