NPI 1154720167

Broc Hammon, DMD

Practitioner Oral and Maxillofacial Surgery (Dentist) Scott Afb, IL

Practice location

Address: 310 W Losey St, Scott Afb, IL 62225-5250
Phone: (618) 256-9355
Fax: (618) 256-7018
Mailing address: 101 Bodin Cir, Travis Afb, CA 94535

Registered specialties (2)

Oral and Maxillofacial Surgery (Dentist) Primary

Dental Providers Taxonomy 1223S0112X Licence 019.032972 (IL)

Other Dentist providers in Illinois →

Dentist

Dental Providers Taxonomy 122300000X Licence 9047230-9921 (UT)

Registry record

NPI: 1154720167
Entity type: Individual
Sex (as registered): Male
NPI issued: 14 Aug 2014
Record last updated: 15 Feb 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.