Provider Demographics
NPI:1144755166
Name:VAN DYKE, HILLARY
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:VAN DYKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2442
Mailing Address - Country:US
Mailing Address - Phone:605-697-6262
Mailing Address - Fax:605-692-1521
Practice Address - Street 1:2220 YORKSHIRE DR
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2442
Practice Address - Country:US
Practice Address - Phone:605-697-6262
Practice Address - Fax:605-692-1521
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD11601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice