Provider Demographics
NPI:1245521624
Name:JAMES H HASTINGS DDS A PROF CORP
Entity type:Organization
Organization Name:JAMES H HASTINGS DDS A PROF CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HAVEN
Authorized Official - Last Name:HASTINGS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-344-8000
Mailing Address - Street 1:2916 TUNNEL ST
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4562
Mailing Address - Country:US
Mailing Address - Phone:530-344-8000
Mailing Address - Fax:
Practice Address - Street 1:2916 TUNNEL ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4562
Practice Address - Country:US
Practice Address - Phone:530-344-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty