MEDICARE: WILLIAM HAMILTON, JR, DMD, LLC

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	3335	AL

General Provider Information

NPI Number	:	1659502623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM HAMILTON, JR, DMD, LLC

Provider Business Mailing Address
First Line	:	106 FORT DALE
Second Line	:
City	:	GREENVILLE
State	:	AL
Zip	:	36037
Country	:	US
Telephone Number	:	334-382-7844
Fax Number	:	334-382-6246

Provider Business Practice Location Address
First Line	:	106 FORT DALE
Second Line	:
City	:	GREENVILLE
State	:	AL
Zip	:	36037
Country	:	US
Telephone Number	:	334-382-7844
Fax Number	:	334-382-6248

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM HAMILTON JR.
Credential	:	DMD
Telephone Number	:	334-382-7844

Provider Enumeration Date	:	08/07/2009
Last Update Date	:	08/07/2009

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