Provider Demographics
NPI:1396359451
Name:HILTON, JEREMIAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:
Last Name:HILTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JEREMIAH
Other - Middle Name:
Other - Last Name:HILTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3009 JEAN RABIN WAY APT 203
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5062
Mailing Address - Country:US
Mailing Address - Phone:405-361-5097
Mailing Address - Fax:
Practice Address - Street 1:7150 MARKET ST STE 130
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9888
Practice Address - Country:US
Practice Address - Phone:910-356-6924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC120391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice