Provider Demographics
NPI:1417361296
Name:HILL DDS PLLC
Entity Type:Organization
Organization Name:HILL DDS PLLC
Other - Org Name:HILL DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-419-0049
Mailing Address - Street 1:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-0166
Mailing Address - Country:US
Mailing Address - Phone:304-586-4292
Mailing Address - Fax:304-562-0356
Practice Address - Street 1:3236 WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213-9603
Practice Address - Country:US
Practice Address - Phone:304-586-4292
Practice Address - Fax:304-562-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2430261QD0000X
WV4109261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3910006298Medicaid