Provider Demographics
NPI:1730334541
Name:HAMPER, PATRICK MOLLOY (DMD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MOLLOY
Last Name:HAMPER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 674
Mailing Address - Street 2:203 E SANTA FE AVE
Mailing Address - City:TOLUCA
Mailing Address - State:IL
Mailing Address - Zip Code:61369-0674
Mailing Address - Country:US
Mailing Address - Phone:815-452-2513
Mailing Address - Fax:815-452-2585
Practice Address - Street 1:203 E SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:TOLUCA
Practice Address - State:IL
Practice Address - Zip Code:61369-0674
Practice Address - Country:US
Practice Address - Phone:815-452-2513
Practice Address - Fax:815-452-2585
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027745122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist