Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 34712 | CA |
NPI | 1245440957 |
---|---|
Provider Name | Dr. Brock Hinton |
First Address | Sacramento, CA 95819-4620 |
Second Address | Sacramento, CA 95819-4620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 18/09/2007 |