| Thane C. Hisaw, Dmd, Pa | |
|
504 E Cornwallis Dr Ste. J Greensboro NC 27405-5679 | |
| (336) 378-1421 | |
| Not Available |
| Full Name | Thane C. Hisaw, Dmd, Pa |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 504 E Cornwallis Dr, Greensboro, North Carolina |
| Authorized Official Name and Position | Thane Hisaw (PRESIDENT) |
| Authorized Official Contact | 9073156812 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thane C. Hisaw, Dmd, Pa 504 E Cornwallis Dr Ste. J Greensboro NC 27405-5679 Ph: (336) 378-1421 | Thane C. Hisaw, Dmd, Pa 504 E Cornwallis Dr Ste. J Greensboro NC 27405-5679 Ph: (336) 378-1421 |
| NPI Number | 1376983213 |
|---|---|
| Provider Enumeration Date | 06/25/2013 |
| Last Update Date | 06/27/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376983213 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 9508 (North Carolina) | Primary |
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