Provider Demographics
NPI:1073766002
Name:G. WADE HANKINS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:G. WADE HANKINS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:G.
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:HANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-936-6108
Mailing Address - Street 1:5647 HIGHWAY 80 E STE 4
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-8907
Mailing Address - Country:US
Mailing Address - Phone:601-936-6108
Mailing Address - Fax:
Practice Address - Street 1:5647 HIGHWAY 80 E STE 4
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-8907
Practice Address - Country:US
Practice Address - Phone:601-936-6108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty