Provider Demographics
NPI:1932342664
Name:HINES, WILEY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILEY
Middle Name:E
Last Name:HINES
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 1:1720 WEST ARLINGTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5998
Mailing Address - Country:US
Mailing Address - Phone:252-353-2111
Mailing Address - Fax:252-353-2115
Practice Address - Street 1:1720 WEST ARLINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5998
Practice Address - Country:US
Practice Address - Phone:252-353-2111
Practice Address - Fax:252-353-2115
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993915Medicaid