Provider Demographics
NPI:1790772739
Name:HILL, JONATHAN W (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:W
Last Name:HILL
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4711 OPUS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8649
Mailing Address - Country:US
Mailing Address - Phone:719-540-3983
Mailing Address - Fax:719-392-1589
Practice Address - Street 1:4711 OPUS DRIVE STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906
Practice Address - Country:US
Practice Address - Phone:719-540-3983
Practice Address - Fax:719-392-1589
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO7447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist