Provider Demographics
NPI:1326163726
Name:HILLIARD FAMILY DENTISTRY, INC.
Entity Type:Organization
Organization Name:HILLIARD FAMILY DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:JEU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-876-8989
Mailing Address - Street 1:3958 LEAP RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1179
Mailing Address - Country:US
Mailing Address - Phone:614-876-8989
Mailing Address - Fax:614-850-9878
Practice Address - Street 1:3958 LEAP RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1179
Practice Address - Country:US
Practice Address - Phone:614-876-8989
Practice Address - Fax:614-850-9878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0-176591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty