MEDICARE: HAMMONS DENTAL, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6614831	UT

General Provider Information

NPI Number	:	1194123463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMMONS DENTAL, PC

Provider Business Mailing Address
First Line	:	2107 W SUNSET BLVD
Second Line	:	SUITE 101
City	:	ST GEORGE
State	:	UT
Zip	:	84770-7139
Country	:	US
Telephone Number	:	435-628-6644
Fax Number	:

Provider Business Practice Location Address
First Line	:	2107 W SUNSET BLVD
Second Line	:	SUITE 101
City	:	ST GEORGE
State	:	UT
Zip	:	84770-7139
Country	:	US
Telephone Number	:	435-628-6644
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATTHEW J HAMMONS
Credential	:	DMD
Telephone Number	:	435-628-6644

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	12/18/2014

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