Provider Demographics
NPI:1407286198
Name:EASTWOOD DENTAL PLLC
Entity Type:Organization
Organization Name:EASTWOOD DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-792-4214
Mailing Address - Street 1:628 EASTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-1602
Mailing Address - Country:US
Mailing Address - Phone:270-781-4880
Mailing Address - Fax:270-781-5929
Practice Address - Street 1:628 EASTWOOD ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-1602
Practice Address - Country:US
Practice Address - Phone:270-781-4880
Practice Address - Fax:270-781-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9259122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty