Provider Demographics
NPI:1508070608
Name:HILLE, DOUGLAS E (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:HILLE
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 1:202 W 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:RITZVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99169-2256
Mailing Address - Country:US
Mailing Address - Phone:509-659-0860
Mailing Address - Fax:
Practice Address - Street 1:202 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:RITZVILLE
Practice Address - State:WA
Practice Address - Zip Code:99169-2256
Practice Address - Country:US
Practice Address - Phone:509-659-0860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA36921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5335500Medicaid