Provider Demographics
NPI:1144357500
Name:HAMBLETON, PAULA WILSON
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:WILSON
Last Name:HAMBLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:24401 MUIRLANDS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3948
Mailing Address - Country:US
Mailing Address - Phone:714-586-6114
Mailing Address - Fax:
Practice Address - Street 1:24401 MUIRLANDS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3948
Practice Address - Country:US
Practice Address - Phone:714-586-6114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice