Individual
BROC HAMMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
9047230-9921
UT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019.032972
IL
Other
Enumeration date
08/14/2014
Last updated
02/15/2022
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