Provider Demographics
NPI:1730828427
Name:HAMPTON, KATLYNN NICOLE (DMD)
Entity type:Individual
Prefix:
First Name:KATLYNN
Middle Name:NICOLE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KATLYNN
Other - Middle Name:NICOLE
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:167 OAKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-7171
Mailing Address - Country:US
Mailing Address - Phone:336-671-9133
Mailing Address - Fax:
Practice Address - Street 1:140 LOCKLAND AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2709
Practice Address - Country:US
Practice Address - Phone:336-722-7534
Practice Address - Fax:336-722-4518
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC127211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice