Basic Information
| Provider Information | |||||||||
| NPI: | 1063578086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMERSKY | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9227 EAST LINCOLN AVE. | ||||||||
| Address2: | SUITE #100 | ||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801245504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203442662 | ||||||||
| FaxNumber: | 7203442663 | ||||||||
| Practice Location | |||||||||
| Address1: | 9227 EAST LINCOLN AVE. | ||||||||
| Address2: | SUITE #100 | ||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801245504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203442662 | ||||||||
| FaxNumber: | 7203442663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 4397 | CO | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
ID Information
| ID | Type | State | Issuer | Description | 4397 | 01 | CO | DENTIST LICENSE NO. | OTHER |