Provider Demographics
NPI:1457492506
Name:HILL, GROVER CLEVELAND JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GROVER
Middle Name:CLEVELAND
Last Name:HILL
Suffix:JR
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 1:195 S ROSEMONT RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4353
Mailing Address - Country:US
Mailing Address - Phone:757-498-6988
Mailing Address - Fax:757-498-8825
Practice Address - Street 1:195 S ROSEMONT RD
Practice Address - Street 2:SUITE 116
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4353
Practice Address - Country:US
Practice Address - Phone:757-498-6988
Practice Address - Fax:757-498-8825
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA46471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4647OtherSTATE DENTAL LICENSE