Provider Demographics
NPI:1750448494
Name:HILLERY, GREGG THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:THOMAS
Last Name:HILLERY
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 1:2 HIGHVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-4724
Mailing Address - Country:US
Mailing Address - Phone:603-669-2688
Mailing Address - Fax:
Practice Address - Street 1:20 S STATE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3725
Practice Address - Country:US
Practice Address - Phone:603-224-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice