Provider Demographics
NPI:1710199120
Name:HINTERMAN, JOHN VIANNEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VIANNEY
Last Name:HINTERMAN
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:G3535 BEECHER RD
Mailing Address - Street 2:STE. J
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2700
Mailing Address - Country:US
Mailing Address - Phone:810-733-7371
Mailing Address - Fax:810-230-2660
Practice Address - Street 1:G3535 BEECHER RD
Practice Address - Street 2:STE. J
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-2700
Practice Address - Country:US
Practice Address - Phone:810-733-7371
Practice Address - Fax:810-230-2660
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901009544122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist