Thane C. Hisaw, DMD, PA

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

9508 Issued in NC

Legal business name

THANE C. HISAW, DMD, PA

Practice address

504 E Cornwallis Dr
Ste. J
Greensboro, NC 27405-5679

Phone

(336) 378-1421

NPI assigned

Jun 25, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Thane Hisaw, DMDNPI 1427180801

Title

President

Phone

(907) 315-6812

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thane C. Hisaw, DMD

  • Pediatric Dentistry
  • Greensboro, NC
  • NPI 1427180801
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372291200000",
    "number": "1376983213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 E CORNWALLIS DR",
            "address_2": "STE. J",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274055679",
            "telephone_number": "336-378-1421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 E CORNWALLIS DR",
            "address_2": "STE. J",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274055679",
            "telephone_number": "336-378-1421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THANE C. HISAW, DMD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-25",
        "last_updated": "2013-06-27",
        "status": "A",
        "authorized_official_last_name": "HISAW",
        "authorized_official_first_name": "THANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-315-6812",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "9508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luwam Tesfa
• Ruth Berhane Tesfalidet, DNP
• Yoab Tesfayohanes
• Colleen Jeske Tetsworth, LCAS, LCSWA
• Kristina Marie Teutonico, PA-C
• Sudan Thapa, MD
• That Advocate Lady
• Irene Thomas Thayil, PA-C
• The Accommodation Station, LLC
• The Alchemy Institute PLLC

• Pediatric Dentistry in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Pediatric Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.