Provider Demographics
NPI:1649723826
Name:HEPWORTH, LINCOLN
Entity type:Individual
Prefix:
First Name:LINCOLN
Middle Name:
Last Name:HEPWORTH
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 1:15470 TEALWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-3602
Mailing Address - Country:US
Mailing Address - Phone:208-390-6004
Mailing Address - Fax:
Practice Address - Street 1:511 S CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1511
Practice Address - Country:US
Practice Address - Phone:214-235-0408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31999122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist