Provider Demographics
NPI:1518195056
Name:HILMO, JUSTIN TODD (DDS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:TODD
Last Name:HILMO
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 1:1789 E COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-6166
Mailing Address - Country:US
Mailing Address - Phone:509-845-9910
Mailing Address - Fax:
Practice Address - Street 1:1840 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1527
Practice Address - Country:US
Practice Address - Phone:480-491-9911
Practice Address - Fax:480-491-9921
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD77641223G0001X
UT7369645-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice