Healthcare Provider Details

I. General information

NPI: 1164536850
Provider Name (Legal Business Name): EDGAR THOMAS HASTINGS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MONADNOCK HIGHWAY
SWANZEY NH
03446
US

IV. Provider business mailing address

116 MONADNOCK HWY
SWANZEY NH
03446-2114
US

V. Phone/Fax

Practice location:
  • Phone: 603-357-7707
  • Fax: 603-352-5628
Mailing address:
  • Phone: 603-357-7707
  • Fax: 603-352-5628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2422
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: