Provider Demographics
NPI:1699339218
Name:HEARNE FAMILY DENTISTRY
Entity type:Organization
Organization Name:HEARNE FAMILY DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHANDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-226-6727
Mailing Address - Street 1:202 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HEARNE
Mailing Address - State:TX
Mailing Address - Zip Code:77859-2508
Mailing Address - Country:US
Mailing Address - Phone:972-670-4991
Mailing Address - Fax:
Practice Address - Street 1:202 W 4TH ST
Practice Address - Street 2:
Practice Address - City:HEARNE
Practice Address - State:TX
Practice Address - Zip Code:77859-2508
Practice Address - Country:US
Practice Address - Phone:972-670-4991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARLIN FAMILY DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-29
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty