Provider Demographics
NPI:1437373529
Name:HILLYARD, GREGORY A (DMD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:HILLYARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 PALMERS MILL RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1030
Mailing Address - Country:US
Mailing Address - Phone:610-355-0984
Mailing Address - Fax:
Practice Address - Street 1:47 STATE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1544
Practice Address - Country:US
Practice Address - Phone:610-566-0291
Practice Address - Fax:610-566-0922
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA024648L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice