Provider Demographics
NPI:1356443410
Name:HILL, RICHARD DANIEL (DMD BA)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DANIEL
Last Name:HILL
Suffix:
Gender:M
Credentials:DMD BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:MS
Mailing Address - Zip Code:38917
Mailing Address - Country:US
Mailing Address - Phone:662-237-4646
Mailing Address - Fax:662-237-4647
Practice Address - Street 1:613 LEXINGTON STREET
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:MS
Practice Address - Zip Code:38917
Practice Address - Country:US
Practice Address - Phone:662-237-4646
Practice Address - Fax:662-237-4647
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2730931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660080Medicaid