Provider Demographics
NPI:1265729768
Name:HINES, DREW W (DMD)
Entity type:Individual
Prefix:DR
First Name:DREW
Middle Name:W
Last Name:HINES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S SHARON AMITY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2898
Mailing Address - Country:US
Mailing Address - Phone:704-366-3526
Mailing Address - Fax:704-366-5121
Practice Address - Street 1:319 S SHARON AMITY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2898
Practice Address - Country:US
Practice Address - Phone:704-366-3526
Practice Address - Fax:704-366-3526
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN193801223G0001X
NC93381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003961900Medicaid