Basic Information
| Provider Information | |||||||||
| NPI: | 1386280303 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SANDI L HAMM DDS COSMETIC & COMPREHENSIVE DENTISTRY PA | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1830 E BROAD ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760639161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174774441 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1830 E BROAD ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760639161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174774441 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2019 | ||||||||
| LastUpdateDate: | 11/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | D'LAINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 8174774441 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.