Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901021219 | MI |
NPI | 1003228966 |
---|---|
Provider Name | Daniel Hammaker |
First Address | Novi, MI 48375-2149 |
Second Address | Novi, MI 48375-2149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2014 |
Last Update Date | 25/05/2020 |