MEDICARE: C. HASTINGS, DDS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1033677901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C. HASTINGS, DDS, LLC

Provider Business Mailing Address
First Line	:	309 CEDAR ST
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-2324
Country	:	US
Telephone Number	:	314-496-3562
Fax Number	:

Provider Business Practice Location Address
First Line	:	1709 HERITAGE HILLS DR
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-4621
Country	:	US
Telephone Number	:	314-496-3562
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. COREY HASTINGS
Credential	:	DDS, MS
Telephone Number	:	314-496-3562

Provider Enumeration Date	:	03/08/2019
Last Update Date	:	02/01/2020

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