Provider Demographics
NPI:1073654117
Name:HASTINGS, JOHNS (DDS)
Entity Type:Individual
Prefix:
First Name:JOHNS
Middle Name:
Last Name:HASTINGS
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 1:1920 SW CRANE CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2218
Mailing Address - Country:US
Mailing Address - Phone:177-278-1903
Mailing Address - Fax:
Practice Address - Street 1:6200 20TH ST STE 292
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1079
Practice Address - Country:US
Practice Address - Phone:772-778-5773
Practice Address - Fax:772-778-6944
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN46071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice