Provider Demographics
NPI:1093998254
Name:HILDING, OWEN HAROLD (DSS)
Entity Type:Individual
Prefix:DR
First Name:OWEN
Middle Name:HAROLD
Last Name:HILDING
Suffix:
Gender:M
Credentials:DSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4365 LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1465
Mailing Address - Country:US
Mailing Address - Phone:708-246-3073
Mailing Address - Fax:
Practice Address - Street 1:4365 LAWN AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1465
Practice Address - Country:US
Practice Address - Phone:708-246-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics