Provider Demographics
NPI:1659414423
Name:HILL, JIMMY V (DMD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:V
Last Name:HILL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2328
Mailing Address - Country:US
Mailing Address - Phone:859-252-0314
Mailing Address - Fax:859-252-0734
Practice Address - Street 1:540 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2328
Practice Address - Country:US
Practice Address - Phone:859-252-0314
Practice Address - Fax:859-252-0734
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY611284945OtherTIN