Provider Demographics
NPI:1548624646
Name:HAMMONS, MADELYN MARIE (RDH)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:MARIE
Last Name:HAMMONS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:HAMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:10822 ENCHANTED WAY SE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OR
Mailing Address - Zip Code:97352-9603
Mailing Address - Country:US
Mailing Address - Phone:503-999-4719
Mailing Address - Fax:
Practice Address - Street 1:10822 ENCHANTED WAY SE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OR
Practice Address - Zip Code:97352-9603
Practice Address - Country:US
Practice Address - Phone:503-999-4719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5055124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist