Provider Demographics
NPI:1164536850
Name:HASTINGS, EDGAR THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:THOMAS
Last Name:HASTINGS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MONADNOCK HWY
Mailing Address - Street 2:
Mailing Address - City:SWANZEY
Mailing Address - State:NH
Mailing Address - Zip Code:03446-2114
Mailing Address - Country:US
Mailing Address - Phone:603-357-7707
Mailing Address - Fax:603-352-5628
Practice Address - Street 1:116 MONADNOCK HIGHWAY
Practice Address - Street 2:
Practice Address - City:SWANZEY
Practice Address - State:NH
Practice Address - Zip Code:03446
Practice Address - Country:US
Practice Address - Phone:603-357-7707
Practice Address - Fax:603-352-5628
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2422122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30003580Medicaid