Basic Information
| Provider Information | |||||||||
| NPI: | 1588721286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMM | ||||||||
| FirstName: | SANDI | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1830 E BROAD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MANSFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174774441 | ||||||||
| FaxNumber: | 8174729753 | ||||||||
| Practice Location | |||||||||
| Address1: | 1830 E BROAD ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760639161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174774441 | ||||||||
| FaxNumber: | 8174729753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 09/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 15795 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.