Provider Demographics
NPI:1053576959
Name:HAMBURG, MARY (DDS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HAMBURG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9112 N. MAY AVE.
Mailing Address - Street 2:
Mailing Address - City:OKLA.CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120
Mailing Address - Country:US
Mailing Address - Phone:405-947-0486
Mailing Address - Fax:405-942-4392
Practice Address - Street 1:9112 N. MAY AVE.
Practice Address - Street 2:
Practice Address - City:OKLA.CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-947-0486
Practice Address - Fax:405-942-4392
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice