Provider Demographics
NPI:1043594930
Name:HILSEN DDS LLC
Entity Type:Organization
Organization Name:HILSEN DDS LLC
Other - Org Name:CLIFFS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HILSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-785-1068
Mailing Address - Street 1:721 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4249
Mailing Address - Country:US
Mailing Address - Phone:201-833-7260
Mailing Address - Fax:
Practice Address - Street 1:721 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4249
Practice Address - Country:US
Practice Address - Phone:201-833-7260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI00961800261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6391330001Medicare NSC