Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 5316 | AL |
NPI | 1104014430 |
---|---|
Provider Name | Dr. William Wells Hammock |
First Address | Fairhope, AL 36532 |
Second Address | Fairhope, AL 36532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2007 |
Last Update Date | 11/10/2007 |