Provider Demographics
NPI:1083294920
Name:LON HINCKLEY DDS PLLC
Entity Type:Organization
Organization Name:LON HINCKLEY DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:LON
Authorized Official - Middle Name:
Authorized Official - Last Name:HINCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-427-6362
Mailing Address - Street 1:4943 STATE HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:DACONO
Mailing Address - State:CO
Mailing Address - Zip Code:80514-9100
Mailing Address - Country:US
Mailing Address - Phone:607-427-6362
Mailing Address - Fax:
Practice Address - Street 1:10160 W 50TH AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2339
Practice Address - Country:US
Practice Address - Phone:607-427-6362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LON HINCKLEY DDS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty