Provider Demographics
NPI:1851471197
Name:HETTINGER & ASSOCIATES DMD PA
Entity Type:Organization
Organization Name:HETTINGER & ASSOCIATES DMD PA
Other - Org Name:CREATIVE DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:HETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-290-0290
Mailing Address - Street 1:1530 CITRUS MEDICAL CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4548
Mailing Address - Country:US
Mailing Address - Phone:407-290-0290
Mailing Address - Fax:407-447-4975
Practice Address - Street 1:1530 CITRUS MEDICAL CT
Practice Address - Street 2:SUITE 102
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4548
Practice Address - Country:US
Practice Address - Phone:407-290-0290
Practice Address - Fax:407-447-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL073558200Medicaid