Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | D009780 | AZ |
N | 1223G0001X | General Practice | 6226 | OK |
N | 213EG0000X | General Practice | 6226 | OK |
NPI | 1083926992 |
---|---|
Provider Name | Dr. Nathan John Hinckley |
First Address | Mesa, AZ 85213-1926 |
Second Address | Peoria, AZ 85382-3825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2010 |
Last Update Date | 17/03/2018 |