Provider Demographics
NPI:1730797556
Name:DIANE I HINES DDS PC
Entity type:Organization
Organization Name:DIANE I HINES DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:INGRAM
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-207-5945
Mailing Address - Street 1:21500 W 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3843
Mailing Address - Country:US
Mailing Address - Phone:248-358-4000
Mailing Address - Fax:248-358-3190
Practice Address - Street 1:21500 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3843
Practice Address - Country:US
Practice Address - Phone:248-358-4000
Practice Address - Fax:248-358-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental