Provider Demographics
NPI:1083779268
Name:HILLSDALE DENTAL ASSOCIATION
Entity Type:Organization
Organization Name:HILLSDALE DENTAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAMESON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-437-7339
Mailing Address - Street 1:1426 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-8314
Mailing Address - Country:US
Mailing Address - Phone:517-437-7339
Mailing Address - Fax:
Practice Address - Street 1:1426 HUDSON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-8314
Practice Address - Country:US
Practice Address - Phone:517-437-7339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14720 17311122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty