Healthcare Provider Details

I. General information

NPI: 1437252814
Provider Name (Legal Business Name): WILLIAM C. HINE JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N GREEN ST
BROWNSBURG IN
46112-1026
US

IV. Provider business mailing address

505 N GREEN ST
BROWNSBURG IN
46112-1026
US

V. Phone/Fax

Practice location:
  • Phone: 317-852-5999
  • Fax: 317-852-6624
Mailing address:
  • Phone: 317-852-5999
  • Fax: 317-852-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12009870
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: