Provider Demographics
NPI:1760651590
Name:HILL, EDWARD WALLACE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WALLACE
Last Name:HILL
Suffix:JR
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 1:102 BRYANT ST
Mailing Address - Street 2:P.O. BOX 488
Mailing Address - City:SAINT GEORGE
Mailing Address - State:SC
Mailing Address - Zip Code:29477-2160
Mailing Address - Country:US
Mailing Address - Phone:843-563-3208
Mailing Address - Fax:843-563-7800
Practice Address - Street 1:102 BRYANT ST
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477-2160
Practice Address - Country:US
Practice Address - Phone:843-563-3208
Practice Address - Fax:843-563-7800
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice