Provider Demographics
NPI:1639252471
Name:HILLER, JOSHUA MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MICHAEL
Last Name:HILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOSHUA
Other - Middle Name:MICHAEL
Other - Last Name:HILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:223 NW 153RD ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-1796
Mailing Address - Country:US
Mailing Address - Phone:801-648-8551
Mailing Address - Fax:
Practice Address - Street 1:14313 NE 20TH AVE
Practice Address - Street 2:SUITE A101
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-1487
Practice Address - Country:US
Practice Address - Phone:360-574-3985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2014-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12241122300000X
WADE601484581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist