Organization
THANE C. HISAW, DMD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THANE HISAW DMD (PRESIDENT)
(907) 315-6812
Entity
Organization
Contact information
Practice address
504 E CORNWALLIS DR, STE. J, GREENSBORO, NC 27405-5679
(336) 378-1421
Mailing address
504 E CORNWALLIS DR, STE. J, GREENSBORO, NC 27405-5679
(336) 378-1421
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
9508
NC
Other
Enumeration date
06/25/2013
Last updated
06/27/2013
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