1881708998 NPI number — DR. CECILLA WICKLIN HINES DMD

Table of content: DR. CECILLA WICKLIN HINES DMD (NPI 1881708998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881708998 NPI number — DR. CECILLA WICKLIN HINES DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINES
Provider First Name:
CECILLA
Provider Middle Name:
WICKLIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881708998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9200 B NAVARRE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAVARRE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-939-6040
Provider Business Mailing Address Fax Number:
850-939-1553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9200 B NAVARRE PKWY
Provider Second Line Business Practice Location Address:
NAVARRE FAMILY DENTISTRY
Provider Business Practice Location Address City Name:
NAVARRE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-939-6040
Provider Business Practice Location Address Fax Number:
850-939-1553
Provider Enumeration Date:
08/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DN9353 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)