Provider Demographics
NPI:1326758137
Name:HILLWOOD FAMILY DENTAL 1774 PLLC
Entity Type:Organization
Organization Name:HILLWOOD FAMILY DENTAL 1774 PLLC
Other - Org Name:HILLWOOD FAMILY DENTAL 1774
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-702-0720
Mailing Address - Street 1:827 MAGNOLIA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-8553
Mailing Address - Country:US
Mailing Address - Phone:281-356-3721
Mailing Address - Fax:
Practice Address - Street 1:827 MAGNOLIA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-8553
Practice Address - Country:US
Practice Address - Phone:281-356-3721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty