Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DS0000002686 | TN |
NPI | 1023150760 |
---|---|
Provider Name | Dr. Edwin H Hines |
First Address | Brentwood, TN 37027-6721 |
Second Address | Brentwood, TN 37027-6721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 19/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DS0000002686 | DENTAL LICENSE (01) | TN |