Provider Demographics
NPI:1548370695
Name:HANCOCK, CARREN HASTINGS (RDH)
Entity type:Individual
Prefix:MRS
First Name:CARREN
Middle Name:HASTINGS
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:CARREN
Other - Middle Name:EDWINA
Other - Last Name:HASTINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:PO BOX 891
Mailing Address - Street 2:
Mailing Address - City:BANGS
Mailing Address - State:TX
Mailing Address - Zip Code:76823
Mailing Address - Country:US
Mailing Address - Phone:325-752-1122
Mailing Address - Fax:
Practice Address - Street 1:2512 CROCKETT DRIVE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801
Practice Address - Country:US
Practice Address - Phone:325-646-4509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3609124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist