=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205161023
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARRY HINDERSTEIN D.D.S., PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2009
-----------------------------------------------------
Last Update Date | 10/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 IRIS ST
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803-2705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-259-9000
-----------------------------------------------------
Fax | 828-251-2067
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 IRIS ST
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803-2705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-259-9000
-----------------------------------------------------
Fax | 828-251-2067
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6784
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------