Provider Demographics
NPI:1497809529
Name:HINKLE, DERRICK JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:JOHN
Last Name:HINKLE
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 1:915 W FETTERMAN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-2449
Mailing Address - Country:US
Mailing Address - Phone:307-684-7533
Mailing Address - Fax:307-684-8960
Practice Address - Street 1:915 W FETTERMAN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-2449
Practice Address - Country:US
Practice Address - Phone:307-684-7533
Practice Address - Fax:307-684-8960
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice