Provider Demographics
NPI:1639295546
Name:HINES, MORGAN B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:B
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 1:418 W 6TH ST
Mailing Address - Street 2:P.O.BOX 628
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3124
Mailing Address - Country:US
Mailing Address - Phone:931-388-3336
Mailing Address - Fax:931-388-3177
Practice Address - Street 1:418 W 6TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3124
Practice Address - Country:US
Practice Address - Phone:931-388-3336
Practice Address - Fax:931-388-3177
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND25521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice