MEDICARE: DR. BUTCH EDWARD HAMLETT 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	3397	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1387417	OTHER	AR	UNITED CONCORDIA
2	5X122	OTHER	AR	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1982634457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BUTCH EDWARD HAMLETT D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 1237
Second Line	:
City	:	PARAGOULD
State	:	AR
Zip	:	72451-1237
Country	:	US
Telephone Number	:	870-236-2300
Fax Number	:	870-236-2304

Provider Business Practice Location Address
First Line	:	622 W COURT ST
Second Line	:
City	:	PARAGOULD
State	:	AR
Zip	:	72450-4247
Country	:	US
Telephone Number	:	870-236-2300
Fax Number	:	870-236-2304

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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