=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760573877
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HINNANT FAMILY DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 10/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2603 HOSPITAL RD
-----------------------------------------------------
City | GOLDSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27534-9424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-735-2226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2603 HOSPITAL RD
-----------------------------------------------------
City | GOLDSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27534-9424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-735-2226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | DR. KEITH F HINNANT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-735-2226
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------