Provider Demographics
NPI:1467773366
Name:HIATT, MONTY DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONTY
Middle Name:DEAN
Last Name:HIATT
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:PO BOX 187
Mailing Address - Street 2:129 N. BRIDGE STREET
Mailing Address - City:JONESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28642-0187
Mailing Address - Country:US
Mailing Address - Phone:336-835-7500
Mailing Address - Fax:336-835-6809
Practice Address - Street 1:129 NORTH BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28642
Practice Address - Country:US
Practice Address - Phone:336-835-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993888Medicaid