MEDICARE: DR. FRANK HAMPSON D.D.S.

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	DS3509	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DS3509	OTHER	TN	LICENSE #
2	0160856	OTHER	TN	BCBS INDIV #
3	803388	OTHER	TN	UCCI ID#
4	0149768	OTHER	TN	COPR BCBS#

General Provider Information

NPI Number	:	1700965829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK HAMPSON D.D.S.

Provider Business Mailing Address
First Line	:	17 BLOOMINGTON CV
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-7939
Country	:	US
Telephone Number	:	731-660-3658
Fax Number	:

Provider Business Practice Location Address
First Line	:	3067 N HIGHLAND AVE
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3411
Country	:	US
Telephone Number	:	731-668-7916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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