Provider Demographics
NPI:1942383542
Name:HINDLEY, NICHOLAS GENE
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:GENE
Last Name:HINDLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-1438
Mailing Address - Country:US
Mailing Address - Phone:641-856-4103
Mailing Address - Fax:
Practice Address - Street 1:203 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1438
Practice Address - Country:US
Practice Address - Phone:641-856-4103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA78911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0152645Medicaid