Provider Demographics
NPI:1992854152
Name:HIATT, JAMES LEE (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LEE
Last Name:HIATT
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 1:1101 NORTH POINT BLVD
Mailing Address - Street 2:STE 126 2ND FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3417
Mailing Address - Country:US
Mailing Address - Phone:410-285-7177
Mailing Address - Fax:410-284-6408
Practice Address - Street 1:1101 NORTH POINT BLVD
Practice Address - Street 2:STE 126 2ND FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3417
Practice Address - Country:US
Practice Address - Phone:410-285-7177
Practice Address - Fax:410-284-6408
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002037341223E0200X
ARAR33871223E0200X
MD167271223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics