Provider Demographics
NPI:1740573187
Name:JEREL D. HILL D.D.S. LLC
Entity Type:Organization
Organization Name:JEREL D. HILL D.D.S. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREL
Authorized Official - Middle Name:DENZIL
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-225-7110
Mailing Address - Street 1:205 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4745
Mailing Address - Country:US
Mailing Address - Phone:801-225-7110
Mailing Address - Fax:801-225-4001
Practice Address - Street 1:205 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4745
Practice Address - Country:US
Practice Address - Phone:801-225-7110
Practice Address - Fax:801-225-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT136284302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528748117000Medicaid