MEDICARE: JAMES RIDGE HAMBERLIN DDS

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	D012727	AZ

General Provider Information

NPI Number	:	1831032580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES RIDGE HAMBERLIN DDS

Provider Business Mailing Address
First Line	:	5455 E GARNET AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-6704
Country	:	US
Telephone Number	:	480-428-9935
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 SPRINGTOWN WAY STE 108
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-3856
Country	:	US
Telephone Number	:	512-717-6053
Fax Number	:

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

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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