Provider Demographics
NPI:1447570262
Name:HILL, RYAN WILLIAM
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:WILLIAM
Last Name:HILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 BANK CT
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52213-9337
Mailing Address - Country:US
Mailing Address - Phone:319-325-1258
Mailing Address - Fax:
Practice Address - Street 1:907 BANK CT
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:IA
Practice Address - Zip Code:52213-9337
Practice Address - Country:US
Practice Address - Phone:319-849-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD96351223G0001X
390200000X
IA089161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program