Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 11653 | TX |
NPI | 1013090737 |
---|---|
Provider Name | Kent M Hamilton |
First Address | San Antonio, TX 78232 |
Second Address | San Antonio, TX 78232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |