MEDICARE: HAMMOCK, DMD & LOTAKIS, DDS VIII, PLLC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1457818122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMMOCK, DMD & LOTAKIS, DDS VIII, PLLC

Provider Business Mailing Address
First Line	:	5821 FAIRVIEW RD STE 220
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-5601
Country	:	US
Telephone Number	:	704-522-1550
Fax Number	:	704-445-7895

Provider Business Practice Location Address
First Line	:	2230 PARK RD STE 202
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-6664
Country	:	US
Telephone Number	:	704-527-2440
Fax Number	:

Authorized Official
Title or Position	:	VP - ACCOUNTS
Name	:	SIMONE WALSH
Credential	:
Telephone Number	:	704-522-1550

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	02/28/2019

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