Provider Demographics
NPI:1356497499
Name:HILLOCK, DONALD LEE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LEE
Last Name:HILLOCK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 COFFEE RD.
Mailing Address - Street 2:BLGD. 4
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:209-522-8800
Mailing Address - Fax:209-522-5126
Practice Address - Street 1:1908 COFFEE RD.
Practice Address - Street 2:BLDG. 4
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-522-8800
Practice Address - Fax:209-522-5126
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice