MEDICARE: DR. NANCY JANE HAMILTON 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	D9138	MN

General Provider Information

NPI Number	:	1811908981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY JANE HAMILTON D.D.S.

Provider Business Mailing Address
First Line	:	1825 BAYARD AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-1212
Country	:	US
Telephone Number	:	651-690-3177
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 W LAKE ST
Second Line	:	SUITE 302
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2554
Country	:	US
Telephone Number	:	612-822-1484
Fax Number	:

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

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

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