Individual
JERALD HAMBLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6301 N OAK TRFY, SUITE 202, GLADSTONE, MO 64118-4705
(816) 452-2420
Mailing address
6301 N OAK TRFY, SUITE 202, GLADSTONE, MO 64118-4705
(816) 452-2420
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
011945
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09692040
BLUE CROSS
MD
Enumeration date
12/13/2007
Last updated
12/13/2007
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