Provider Demographics
NPI:1356469779
Name:HASTINGS, MARK MITCHELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MITCHELL
Last Name:HASTINGS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:755 COMMERCE DR
Mailing Address - Street 2:SUITE 901
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2627
Mailing Address - Country:US
Mailing Address - Phone:404-378-3083
Mailing Address - Fax:404-378-1619
Practice Address - Street 1:755 COMMERCE DR
Practice Address - Street 2:SUITE 901
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2627
Practice Address - Country:US
Practice Address - Phone:404-378-3083
Practice Address - Fax:404-378-1619
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN00094331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice