Provider Demographics
NPI:1720004518
Name:HILL, O JERRY JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:O
Middle Name:JERRY
Last Name:HILL
Suffix:JR
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 1:925 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3484
Mailing Address - Country:US
Mailing Address - Phone:704-873-0263
Mailing Address - Fax:704-873-1813
Practice Address - Street 1:925 THOMAS ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3484
Practice Address - Country:US
Practice Address - Phone:704-873-0263
Practice Address - Fax:704-873-1813
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC42051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-93902Medicaid
NC89-93902Medicaid
NCU63810Medicare UPIN