Provider Demographics
NPI:1144238973
Name:HILLS, EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:HILLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 WADE PARK AVE
Mailing Address - Street 2:MH AT ELIZA BRYANT VILLAGE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-2765
Mailing Address - Country:US
Mailing Address - Phone:216-957-9920
Mailing Address - Fax:
Practice Address - Street 1:7201 WADE PARK AVE
Practice Address - Street 2:MH AT ELIZA BRYANT VILLAGE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-2765
Practice Address - Country:US
Practice Address - Phone:216-957-9920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0987973Medicaid