Provider Demographics
NPI:1518033380
Name:HILARIO, ROSANNA (DDS)
Entity Type:Individual
Prefix:
First Name:ROSANNA
Middle Name:
Last Name:HILARIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 PAULISON AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3806
Mailing Address - Country:US
Mailing Address - Phone:973-778-7272
Mailing Address - Fax:
Practice Address - Street 1:2907 VINELAND RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-5505
Practice Address - Country:US
Practice Address - Phone:407-396-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-25
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0206271223G0001X
FLDN167441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8366209Medicaid
NJ014861OtherAMERIGROUP ID NUMBER