Healthcare Provider Details

I. General information

NPI: 1538781224
Provider Name (Legal Business Name): ADAM HINE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

1170 UNIVERSITY VLG
SALT LAKE CITY UT
84108-3504
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-1621
  • Fax: 801-662-3908
Mailing address:
  • Phone: 385-424-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number11781985-0702
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11781985-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: