Healthcare Provider Details

I. General information

NPI: 1033677901
Provider Name (Legal Business Name): C. HASTINGS, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 02/01/2020
Certification Date: 02/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 HERITAGE HILLS DR
WASHINGTON MO
63090-4621
US

IV. Provider business mailing address

309 CEDAR ST
WASHINGTON MO
63090-2324
US

V. Phone/Fax

Practice location:
  • Phone: 314-496-3562
  • Fax:
Mailing address:
  • Phone: 314-496-3562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. COREY HASTINGS
Title or Position: OWNER
Credential: DDS, MS
Phone: 314-496-3562