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Individual

DR. MYLES JORDAN HASTINGS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
1017 BROADWAY AVE, MATTOON, IL 61938-4120
(217) 235-0381
(217) 235-0396
Mailing address
1017 BROADWAY AVE, MATTOON, IL 61938-4120
(217) 235-0381

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.031605
IL

Other

Enumeration date
06/11/2018
Last updated
06/11/2018
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