Provider Demographics
NPI:1669665410
Name:GARY P HILL DDS MS
Entity Type:Organization
Organization Name:GARY P HILL DDS MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:919-493-2569
Mailing Address - Street 1:3115 ACADEMY ROAD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707
Mailing Address - Country:US
Mailing Address - Phone:919-493-2569
Mailing Address - Fax:919-493-5437
Practice Address - Street 1:3115 ACADEMY ROAD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707
Practice Address - Country:US
Practice Address - Phone:919-493-2569
Practice Address - Fax:919-493-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36791223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
93898OtherBLUE CROSS BLUE SHIELD
NC8993898Medicaid
NC39467Medicare UPIN