Provider Demographics
NPI:1730251539
Name:HAMMOCK, CLARK BRODIE (DMD)
Entity type:Individual
Prefix:DR
First Name:CLARK
Middle Name:BRODIE
Last Name:HAMMOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 FAIRVIEW RD STE 220
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-5601
Mailing Address - Country:US
Mailing Address - Phone:704-522-1550
Mailing Address - Fax:704-445-7896
Practice Address - Street 1:2230 PARK RD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6664
Practice Address - Country:US
Practice Address - Phone:704-527-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8271122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist