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NPI Code Detail

MEDICARE: DR. THOMAS BLAIR HINES JR. D.D.S.

MEDICARE: DR. THOMAS BLAIR HINES JR. D.D.S.
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
11223S0112XOral and Maxillofacial Surgery (Dentist)7140NC
21223S0112XOral and Maxillofacial Surgery (Dentist)8095SC
3122300000XDentist7140NC

General Provider Information

NPI Number : 1720067416
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS BLAIR HINES JR. D.D.S.
Provider Business Mailing Address
First Line : 9300 DEWITT LOOP
Second Line :
City : FORT BELVOIR
State : VA
Zip : 22060-5285
Country : US
Telephone Number : 919-291-4322
Fax Number :
Provider Business Practice Location Address
First Line : PSC 475 BOX 1
Second Line :
City : FPO
State : AP
Zip : 96350-1200
Country : US
Telephone Number : 919-291-4322
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2006
Last Update Date : 09/03/2024

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