Basic Information
| Provider Information | |||||||||
| NPI: | 1033279229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASTINGS | ||||||||
| FirstName: | REGE | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | ALAMOSA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 811012290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195895161 | ||||||||
| FaxNumber: | 7195895722 | ||||||||
| Practice Location | |||||||||
| Address1: | 903 S 12TH ST | ||||||||
| Address2: | |||||||||
| City: | ROCKY FORD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810672127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192547623 | ||||||||
| FaxNumber: | 7192545112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 532 | CO | Y | Dental Providers | Dentist |
No ID Information.