=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518160951
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN H HASTINGS DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9340 W SAHARA AVE STE 202
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89117-8803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-646-2020
-----------------------------------------------------
Fax | 702-798-9099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1730 DUNEVILLE ST
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89146-1255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-616-1539
-----------------------------------------------------
Fax | 702-798-9099
-----------------------------------------------------
=====================================================
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 | 4317
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------