Provider Demographics
NPI:1023150760
Name:HINES, EDWIN H (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:H
Last Name:HINES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8217 WHITE CHAPEL CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-6721
Mailing Address - Country:US
Mailing Address - Phone:615-370-3229
Mailing Address - Fax:
Practice Address - Street 1:8217 WHITE CHAPEL CT
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-6721
Practice Address - Country:US
Practice Address - Phone:615-370-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000026861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDS0000002686OtherDENTAL LICENSE