Provider Demographics
NPI:1487949079
Name:COLLETTE AND HAMILTON DDS PLLC
Entity type:Organization
Organization Name:COLLETTE AND HAMILTON DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTISTRY FOR KIDS RICHLAND
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-585-5437
Mailing Address - Street 1:3911 W 27TH AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-2483
Mailing Address - Country:US
Mailing Address - Phone:509-585-5437
Mailing Address - Fax:509-585-5438
Practice Address - Street 1:2671 QUEENSGATE DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9103
Practice Address - Country:US
Practice Address - Phone:509-585-5437
Practice Address - Fax:509-585-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000111961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA603-117-339OtherSEC OF STATE UBI