Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 30021019 | OH |
NPI | 1003824830 |
---|---|
Provider Name | Dr. Nicholas L Hammermeister |
First Address | Streetsboro, OH 44241-5625 |
Second Address | Streetsboro, OH 44241-5625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 30/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20-1710440 | TAX ID # (01) | OH |
2135040 | (05) | OH |
30. 021019 | STATE LICENSE # (01) | OH |
U78789 | (02) | OH |