Provider Demographics
NPI:1598389678
Name:HINES, BRIANNA NICHOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:NICHOLE
Last Name:HINES
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BAYARD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-1504
Mailing Address - Country:US
Mailing Address - Phone:917-680-5304
Mailing Address - Fax:
Practice Address - Street 1:947 S LAKE BLVD STE A
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-3255
Practice Address - Country:US
Practice Address - Phone:845-621-2424
Practice Address - Fax:845-621-1360
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT139401223P0221X
NY19810321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry