Provider Demographics
NPI:1538312962
Name:JENNIFER HAMILTON, DDS, MS INC.
Entity type:Organization
Organization Name:JENNIFER HAMILTON, DDS, MS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:304-645-2088
Mailing Address - Street 1:200 E RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1130
Mailing Address - Country:US
Mailing Address - Phone:304-645-2088
Mailing Address - Fax:
Practice Address - Street 1:200 E RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1130
Practice Address - Country:US
Practice Address - Phone:304-645-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810017608Medicaid
WV0135641000Medicaid
WV3810017610Medicaid
VA221728Medicaid