Provider Demographics
NPI:1497067102
Name:HINES, CHAD I (DDS)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:I
Last Name:HINES
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 1:15640 N 7TH ST STE A4
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3520
Mailing Address - Country:US
Mailing Address - Phone:319-331-3709
Mailing Address - Fax:
Practice Address - Street 1:15640 N 7TH ST STE A4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3520
Practice Address - Country:US
Practice Address - Phone:602-843-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist