Provider Demographics
NPI:1417967530
Name:ST HILL, WAYNE WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:WILLIAM
Last Name:ST HILL
Suffix:
Gender:M
Credentials:DDS
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 235
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12484-0235
Mailing Address - Country:US
Mailing Address - Phone:845-687-0600
Mailing Address - Fax:845-687-7296
Practice Address - Street 1:10 GAGNON DRIVE
Practice Address - Street 2:RTE 209
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484
Practice Address - Country:US
Practice Address - Phone:845-687-0600
Practice Address - Fax:845-687-7296
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034680122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00465316Medicaid