Healthcare Provider Details

I. General information

NPI: 1992854152
Provider Name (Legal Business Name): JAMES LEE HIATT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NORTH POINT BLVD STE 126 2ND FLOOR
BALTIMORE MD
21224-3417
US

IV. Provider business mailing address

1101 NORTH POINT BLVD STE 126 2ND FLOOR
BALTIMORE MD
21224-3417
US

V. Phone/Fax

Practice location:
  • Phone: 410-285-7177
  • Fax: 410-284-6408
Mailing address:
  • Phone: 410-285-7177
  • Fax: 410-284-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number00203734
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberAR3387
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number16727
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: