Provider Demographics
NPI:1083926992
Name:HINCKLEY, NATHAN JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JOHN
Last Name:HINCKLEY
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 1:2834 E PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-1926
Mailing Address - Country:US
Mailing Address - Phone:405-651-5889
Mailing Address - Fax:
Practice Address - Street 1:8085 W BELL RD STE 103
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3825
Practice Address - Country:US
Practice Address - Phone:623-878-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK62261223G0001X
AZD0097801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice