Provider Demographics
NPI:1528416963
Name:HINCKLEY, LON SAMUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LON
Middle Name:SAMUEL
Last Name:HINCKLEY
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 1:4943 STATE HIGHWAY 52 STE 260
Mailing Address - Street 2:
Mailing Address - City:DACONO
Mailing Address - State:CO
Mailing Address - Zip Code:80514-9108
Mailing Address - Country:US
Mailing Address - Phone:607-427-6362
Mailing Address - Fax:
Practice Address - Street 1:4943 STATE HIGHWAY 52 STE 260
Practice Address - Street 2:
Practice Address - City:DACONO
Practice Address - State:CO
Practice Address - Zip Code:80514-9108
Practice Address - Country:US
Practice Address - Phone:607-427-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-187121223S0112X
WY15481223S0112X
OH390200000X
CODEN.002046451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program