Provider Demographics
NPI:1942556733
Name:ERIC D. HINKLE, DDS, INC.
Entity type:Organization
Organization Name:ERIC D. HINKLE, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:HINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-742-6400
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:CRAIGSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26205-0465
Mailing Address - Country:US
Mailing Address - Phone:304-742-6400
Mailing Address - Fax:
Practice Address - Street 1:16100 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:CRAIGSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26205-8858
Practice Address - Country:US
Practice Address - Phone:304-742-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV35061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4002089000Medicaid