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General NPI Number Information
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NPI Number | 1649464413
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Entity Type | Individual
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Provider Name | LARRY THOMAS HINSON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 25G STONEBROOK PL # 172
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City | JACKSON
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State | TN
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Zip | 38305-3637
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Country | US
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Telephone | 731-414-8045
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Fax |
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Provider Business Mailing Address
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Address Line | 25G STONEBROOK PL # 172
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City | JACKSON
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State | TN
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Zip | 38305-3637
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Country | US
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Telephone | 731-414-8045
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS0000006993
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License Number State | TN
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