Provider Demographics
NPI:1942233713
Name:HIFKO, NATHANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:
Last Name:HIFKO
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 1:8159 RAEFORD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-5981
Mailing Address - Country:US
Mailing Address - Phone:910-826-4900
Mailing Address - Fax:910-826-4943
Practice Address - Street 1:8159 RAEFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-5981
Practice Address - Country:US
Practice Address - Phone:910-826-4900
Practice Address - Fax:910-826-4943
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8373122300000X
NC8262122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBH9784364OtherDEA
KYBH9784364OtherDEA